Disk Battery Ingestion And Tracheoesophageal Fistula – A Comparative Review Of Two Cases.

Abstract

The incidence of disk battery ingestion is increasing and parallels the increasing use of electronic devices. 2 Children less than 6 years are mostly involved with a peak incidence in 1 to 3 year old. Most ingested disk battery pass harmlessly through the gastrointestinal tract. Lodgments in the aerodigestive tract require immediate endoscopic removal to prevent or minimize major sequelae or fatality such as esophageal perforation, Tracheoesophageal Fistula (TEF) and aorta-esophageal fistula. 3, 5, 6, TEF secondary to disk battery ingestion has been reported within 4-6hrs of ingestion and lodgement. 7 We saw for the first time in our region, South-Eastern Nigeria, two babies aged 13 and 14 months with disk battery ingestion and lodgment in the esophagus of 6-7weeks and 48-72 hours duration respectively. They presented within 4 months between September, 2010 and January, 2011. The first baby was misdiagnosed and managed by the family physician and pediatrician for respiratory tract infection and later Asthma without significant improvement. The second baby was promptly and correctly diagnosed and appropriately managed. Both babies had endoscopic evaluation and removal of the Disk battery of similar type (Lithium) and size (20mm). Lodgment was in the lower cervical esophagus, 12-14 cm from the upper incisor tooth in both cases. Tracheoesophageal fistula was an accompanying major sequelae within 48-72 hour of lodgment in one baby while the other baby ran a relatively a benign course without esophageal perforation despite over 6 weeks of lodgment. The anode (-) surface of the disk battery was forward facing in the baby with TEF and backward-facing in the baby with the benign course.The forward-facing anode (-) surface of impacted disk battery seemed independent of duration of lodgment as a risk factor to the rapid development of tracheoesophageal fistula. This further highlights the need for a prompt endoscopic evaluation and removal of impacted disk battery in the esophagus. Nigeria is a rapidly developing economy with increasing use of electronic devices; therefore an aggressive awareness campaign is needed to prevent increasing incidence and morbidity that accompany late presentation to the hospital. A high index of suspicion is needed by family physicians and pediatrician to for early diagnosis and reduced complications and mortality of disk battery ingestion in children in Nigeria. The relevance of simple plain radiograph of the neck, chest and abdomen in a seeming comfortable and well child with suspicion of foreign body ingestion is emphasized.