Abstract
Objective To present the clinical profile and outcomes of esophageal button battery ingestion cases treated at our institution over an 8-year period. Methods A total of 17 children who presented after ingesting a button battery and were treated at a tertiary care clinic over an 8-year period were included in this retrospective case series study. Data on patient demographics and esophageal location of the battery, time from ingestion to admission, symptoms, grade of mucosal injury, size of the battery, management, complications, and follow-up outcome were recorded. Results Median age was 29 months (range, 2–99 months). Boys comprised (n=11, 64.7%) of the study population. The most common location was the proximal esophagus (n=10, 58.8%). The median time from ingestion to admission was 6 h (range, 3–24 h). Hypersalivation alone (n=6, 35.3%) or together with vomiting (n=5, 29.4%) was the most common symptom. Grade IIA mucosal injury was noted in six (n=6, 35.3%) patients. The diameter of the battery was a median of 18.0 mm (range, 14–22 mm). We did not observe any correlation between the size of the battery and the grade of the injury. Early postoperative complications were encountered in one patient (n=1, 5.8%) and late postoperative complications were noted in eight patients (n=8, 47.1%) which required further esophageal dilatations, and follow-up revealed normal findings in eight patients (n=8, 47.1%) and mortality occurred in one patient. Conclusion The current case series study describing the clinical profiles and outcomes of 17 children who had ingested an esophageal button battery revealed male predominance, young patient age, and admission after a median of 6 h (3–24 h) of ingestion with nonspecific symptoms. Our findings confirm the success of rigid endoscopy to remove esophageal button batteries and indicate the likelihood of severe complications after removal.
Highlights
Is retrospective case series study was designed to present the clinical profiles and outcomes of esophageal button battery ingestion cases treated at our institution over an 8-year period
Anesthesia was induced with 2 mg/kg propofol or 3 mg/kg pentothal injection, and 1 μg/kg remifentanil was administered as narcotic analgesia. e anesthesia was maintained with 2–4% sevoflurane in a 50% O2/50% air mixture, and the operation continued under controlled ventilation. e batteries were removed using rigid esophagoscopy and a foreign body forceps
A 2-month-old boy with a recurrent pulmonary infection and fever was admitted 40 days after ingesting a battery. e battery was located in the proximal esophagus, and surgery was required due to development of a tracheoesophageal fistula (Figure 1 and Table 2)
Summary
Ingestion of a button battery by children is considered an absolute surgical emergency and a dangerous and challenging form of foreign body ingestion that requires a rapid diagnosis and urgent removal [1,2,3].An increase in button battery ingestion rates in children has occurred in recent years due to the spread of home multimedia devices that use larger batteries that may lead to life-threatening consequences, such as perforation or fistula, in the case of esophageal impaction, even after removal of the battery from the esophagus [1,2,3,4,5].Ingesting a button battery carries the risk of rapidly progressing and potentially life-threatening damage to the esophagus, due to electrical injuries (flow of electrical current from the positive to negative terminals of the battery bridged by the mucosa), mechanical injuries (pressure necrosis by mucosal compression), and caustic injuries (leakage of alkaline electrolytes and coagulative necrosis) [2, 3, 5,6,7,8,9].Given experimental and clinical data that show that coagulative necrosis starts within 15 min of battery-esophageal contact [10] and that major corrosive injury begins within hours of ingestion [11]; the urgent endoscopic removal of a battery from the esophagus is a well-accepted approach [1].is retrospective case series study was designed to present the clinical profiles and outcomes of esophageal button battery ingestion cases treated at our institution over an 8-year period.Emergency Medicine International. An increase in button battery ingestion rates in children has occurred in recent years due to the spread of home multimedia devices that use larger batteries that may lead to life-threatening consequences, such as perforation or fistula, in the case of esophageal impaction, even after removal of the battery from the esophagus [1,2,3,4,5]. Given experimental and clinical data that show that coagulative necrosis starts within 15 min of battery-esophageal contact [10] and that major corrosive injury begins within hours of ingestion [11]; the urgent endoscopic removal of a battery from the esophagus is a well-accepted approach [1].
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