Timeliness of management of button battery impactions in children in the province of Ontario: a multi-center analysis.

Introduction The foreign body of the esophagus—button battery causes severe changes of the esophagus. Ingestion of large-sized button batteries (≥20 mm) in children younger than 4 years is associated with increased morbidity and mortality. The most serious complication is the perforation of the esophagus or tracheoesophageal fistula (TEF), which may require a long-term multistage surgical treatment. Other issues that can be caused by button battery injury are esophageal stenosis and laryngeal paralysis. There are 40 children with esophageal injuries who were treated in Filatov Children Hospital between 2011 and 2019. Among them, several children did not need surgical treatment at all (40%), but five patients (12.5%) needed colon transposition. Button battery injury also causes reversible or irreversible damage of the recurrent laryngeal nerve, which required complex reconstructive operations on the larynx and trachea. Patients and Methods We retrospectively analyzed 40 patients with different types of injury after button battery removal. The average age of the patients was 1 year and 8 months. A total of 16 patients (40%) have had no esophageal or laryngeal pathology after button battery removal. Six patients (15%) developed esophageal stenosis. Two patients (5%) had esophageal perforations. Sixteen patients (40%) developed TEF. Bivocal chord paralysis was identified in 10 patients (25%). Results Esophageal dilations were performed in five patients (12.5%). Eight patients (20%) underwent laparoscopic fundoplication and gastrostomy. Spontaneous TEF closure formed in four patients (10%). Ten patients (25%) underwent different types of reconstructive surgeries in different periods after battery removal. Among eight patients (20%) who underwent early reconstructive surgeries three (7.5%) developed different complications, which require esophageal replacements. Tracheostomy was performed in 11 children (27.5%), five (12.5%) of whom required reconstructive surgery on the larynx. There was no mortality in our observation. Conclusion In this study, we conclude that TEF after button battery removal can close spontaneously and should not be operated in the acute period. Fundoplication and gastrostomy and tracheostomy can be procedures of choice in these patients. Also recurrent nerve injuries can be unstable. They can cause severe injuries of esophagus, trachea, and larynx, which can require esophageal replacement and vocal chord lateralization procedures with long-term and multiple-stage treatment.

Button batteries are the second most frequently-ingested foreign bodies and can lead to serious clinical complications within hours of ingestion. The purpose of this study was to analyze the outcomes of 14 children with button batteries lodged in the upper gastrointestinal tract.Totally 14 children with button batteries lodged in the upper gastrointestinal tract were included. The diagnosis was made primarily by the history of button battery ingestion, physical examination and chest-abdomen X-ray examination.The button batteries lodged in the esophagus were removed by esophagoscope, and those in the gastrointestinal tract were under observation. Among 10 children with batteries in the first esophageal stenosis, 9 were cured and 1 suffered from tracheoesophageal fistula. One case of battery in the second esophageal stenosis was dead due to intercurrent aortoesophageal fistula. Two cases of batteries in the third esophageal stenosis were cured after removal, and 1 case of the battery in the gastrointestinal tract discharged spontaneously.Ingested button batteries are mainly lodged in the esophageal stenoses and are easy to cause esophageal injury and severe complications. Early detection, prompt treatment, strengthening observation and regular follow-up after discharge may help to decrease the incidence of complications and improve the outcomes.

Evaluating the management timeline of tracheoesophageal fistulas secondary to button batteries: A systematic review

BACKGROUND Although the ingestion of button batteries (BBs) in neonates is exceedingly rare, it poses severe clinical challenges with potentially catastrophic outcomes. The increase in such cases, particularly among toddlers, is largely due to the widespread availability of portable electronic devices. Ingestion of button or disk batteries is notably more dangerous than other foreign bodies, often leading to acute complications such as burns and esophageal perforation. This report details the diagnosis and management of a 21-day-old neonate who presented with a button battery lodged in the esophagus. CASE REPORT We report the case of a 21-day-old neonate who initially presented with 3 days of persistent vomiting. Diagnostic imaging with a chest radiograph revealed a radiopaque foreign body in the esophagus, identified as a button battery. It was suspected that the battery was inadvertently placed in the neonate's mouth by a sibling with an intellectual disability. Initial attempts to remove the battery using 4-, 5-, and 6-mm endoscopes were unsuccessful. However, extraction was eventually accomplished with a 2.5-mm rigid esophagoscope. Following the removal, the neonate developed significant complications, including a tracheoesophageal fistula and esophageal stenosis. Extensive follow-up care led to a full recovery, demonstrating resilience despite the severe initial challenges. CONCLUSIONS This report emphasizes the critical need for swift identification and removal of ingested button batteries. It details the diagnostic and management strategies employed for a neonate, illustrating the urgency and precision required in such cases.

Introduction:Button batteries represent a low percentage of all foreign bodies swallowed by children and esophageal location is even less frequent. However, these cases are more likely to develop severe injuries. The aim of this essay is to report three cases treated in our institution and review previous reports.Material and Methods:Chart review and literature search.Case Reports:We treated three children between 2-7- years old with button batteries lodged at esophagus. They all presented esophageal burns (EB), which evolved in esophageal stenosis in two out of the three cases.Results:We found 29 more cases in literature and the injuries included EB, esophageal perforation (EP) and tracheoesophageal fistula (TEF).Discussion:Swallowed button batteries rarely remain in esophagus, but these cases present a higher risk of tisular damage. Injuries can take place even after few hours; and therefore, endoscopy must be performed as soon as possible. Further study on button batteries’ safety and the establishment of a maximum size for them would be good preventive measures.

Figure: Frontal upright radiograph of the chest (left) shows a round metallic foreign object in the expected location of the proximal esophagus. Once magnified (right), the foreign body exhibits a double contour appearance (arrows). This corresponds to the shape of a button battery. Note regions of irregularity and lucency about the periphery of the button battery (arrowheads in 1b), which indicate corrosion of the battery itself.FigureFigureFigureAn 11-month-old girl was brought to the emergency department with a two-week history of pooling secretions and feeding intolerance. A chest radiograph was performed, and detected a button battery. ENT was consulted emergently, and the patient was taken to the operating room for a laryngoscopy. The battery was retrieved, and the patient was found to have erosion and perforation of the posterior esophageal wall, which was repaired. She was discharged home following a prolonged stay in the pediatric ICU. Six months later, the patient presented with cough and repeated bouts of emesis. An esophagram was performed, which showed focal high-grade narrowing in the proximal esophagus. This was an esophageal stricture that developed as a delayed complication of button battery ingestion and battery cell corrosion within the esophagus. Most cases of button battery ingestion result in spontaneous passage through the gastrointestinal tract, but impaction of the button battery in the esophagus can result in considerable morbidity and even mortality. This holds a high risk for severe injury to esophageal mucosa, including full-thickness erosion resulting in perforation. The mechanism for injury is only partially from pressure necrosis. The primary hazard of button batteries (as opposed to other foreign bodies of similar shape, like coins) lies in its ability to induce a current and hydrolyze tissue fluids to produce hydroxide, causing rapid tissue erosion and injury to the esophageal wall. Eventually, corrosion of the battery cell can result in the leakage of battery contents, which causes further injury and toxicity.Figure: Spot image from an esophagram (left) shows focal narrowing in the proximal esophagus (arrow). Magnification of the level of narrowing (right) better delineates the abrupt tapering of the esophagus, indicative of a stricture at this level and dilation of the more proximal esophagus and hypopharynx secondary to downstream obstruction.It was reasonable to conclude based on the radiographic evidence of battery cell corrosion that significant esophageal injury had already occurred. An emergent laryngoscopy showed a full-thickness injury resulting in perforation of the posterior esophageal wall. Button battery ingestion poses a risk for delayed complications such as tracheoesophageal fistula and esophageal stricture, in addition to an acute injury. Early diagnosis is key in managing ingested button batteries, and in cases of impaction within the esophagus, prompt retrieval is crucial not only to avoid acute injury but to prevent delayed complications that may necessitate additional invasive interventions. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

Button battery ingestion as a life threatening condition in pediatric practice

Drooling, Irritability, and Refusal to Eat in a 22-Month-Old Child

Patient: Male, 2-year-oldFinal Diagnosis: Button battery induced tracheoesophageal fistula and recurrenceSymptoms: Cough • difficulty in swallowing • irritability • lethargy • vomitingMedication: —Clinical Procedure: Buttery removal with tracheoesophageal fistula closure through cervical incision • exploration with esophagostomy and gastrostomy • recurrent tracheoesophageal fistula repair and esophageal anastomosis through thoracotomySpecialty: Otolaryngology • Pediatrics and Neonatology • SurgeryObjective:Unusual clinical courseBackground:Among the pediatric population, button batteries ingestion is a significant health risk. The main treatment of ingested esophageal button batteries is urgent endoscopic removal. Missed or delayed diagnosis results in serious complications and outcomes. In the literature, high morbidity and mortality have been described in cases of button battery ingestion. By reporting this case we aim to encourage physicians to raise their suspicion of foreign body ingestion in similar pediatric cases and to review the different management approaches in the case of foreign body-induced tracheoesophageal fistula.Case Report:A 2-year-old boy was referred to us with difficulty in swallowing solids and liquids, with tactile fever for 1 month. A chest X-ray showed a radiopaque foreign body consistent with a button battery. The battery was removed through surgical cervical incision followed by closure of an identified tracheoesophageal fistula, cervical loop esophagostomy, and gastrostomy. After 6 months of follow-up and gastrostomy feeding, recurrence of the tracheoesophageal fistula was identified, for which surgical closure and esophageal anastomosis were performed. A postoperative esophagogram done on day 7 showed no leak or evidence of tracheoesophageal fistula; the patient started oral feeding and the gastrostomy tube was removed.Conclusions:Even in the absence of witnessed ingestion, the persistent nonspecific symptoms must raise the suspicion of foreign body ingestion in the pediatric age group. Failure of endoscopic removal of the battery is a possibility that need to be included in management algorithms. Surgical repair is the most frequently described approach for foreign body-induced tracheoesophageal fistula repair.

Among foreign body ingestions in children, button battery ingestion is becoming increasingly common. When the battery is impacted in the oesophagus, the risk of complications is significant. The aim of this study was to share our experience in managing children with oesophageal button battery impaction and assess the occurrence of short-term and long-term complications. This was a retrospective study conducted at a tertiary French paediatric centre. Children with oesophageal button battery impaction managed between 1 January 2017 and 31 December 2022 were included. Clinical data, endoscopic findings and treatments were recorded at battery removal and during follow-up at 1 week and at 1, 3 and 12 months. Complications were noted at each follow-up. Patients were compared based on the presence or absence of complications to identify associated risk factors. Among 79 children included in the study, 31 experienced one or more complications by 12 months postingestion: oesophageal stenosis (n=14), mediastinitis (n=18), tracheoesophageal fistula (n=3), oesophageal perforation (n=5) and vocal cord paralysis (n=3). Most complications were diagnosed within the first week, except for oesophageal stenosis, which had an average delay of 38.2 days. Risk factors for complications included younger age, longer time to battery removal and oesophageal mucosal necrosis observed during follow-up endoscopy 1 week postremoval. The rate of complications following oesophageal button battery impaction remains high. However, protocolised management involving rapid battery extraction, early endoscopic review and intraoperative nasogastric tube placement may reduce the risk of severe complications and oesophageal stenosis.

Button batteries have been recognized as one of the dangerous foreign bodies to children for more than 30 years, but few related studies have been published to give more concern in China. We reported 6 cases of button battery intake as foreign body in children. The Chinese literature on button battery as foreign body in children was reviewed. The interval between the accidental ingestion and battery removal ranged from 6 hours to 3 days. Two patients had no sequela, 3 patients had tracheoesophageal fistulas, and 1 patient had nasal septal perforation. Twenty-eight articles about button battery as foreign body in children were obtained by Chinese-language literature searches including 25 case reports, 2 health education articles, and 1 imaging article. In total, 172 cases of button battery intake as foreign body in children were identified, 23 and 10 of the 159 cases involving nasal button battery lodgment developed nasal septal perforation and nasal adhesion, respectively. Tracheoesophageal fistula was identified in 4 of the 12 ingestion cases. One case of button battery intake was in external auditory canal. A small number of children with button battery as foreign body were reported in China, which is 1 of the biggest countries with large population of children.

Background Impaction of button batteries (BB) in children is not rare Aim To conduct a systematic review of reports of oesophageal injury caused by impaction of BB in children in China. Methods The databases of Wanfang, VIP, China National Knowledge Internet, the Chinese Medical Association Journal and PubMed were searched for reports by Chinese authors of BB impaction published between May 2005 and July 2023. The risk factors for complications were analysed by multiple unconditional logistic regression. Results After excluding 95 articles which did not meet the criteria, 77 remained, with a total of 964 cases of BB impaction. Of 516 cases with complications, 402 were in children (77.9%). The most common complications were oesophageal erosions and ulceration (218/402, 54.2%), followed by oesophageal perforation (88/402, 21.1%), tracheo-oesophageal fistula (69/402, 17.2%), oesophageal stricture (38/402, 9.5%) and peri-oesophagitis (31/402, 7.7%). Regression analysis demonstrated that the duration and location of impaction were the risk factors for complications (OR 13.7 and 11.3, respectively; p < 0.05 for both). Conclusion BB impaction remains common and causes serious oesophageal complications in children. Widespread knowledge of the risks is essential for prevention.

Objective To investigate the clinical efficacy of magnetic compression anastomosis for congenital esophageal atresia and stenosis. Methods The retrospective and descriptive study was conducted. The clinical data of 4 children who underwent magnetic compression anastomosis for congenital esophageal atresia and stenosis in the Northwest Women and Children′s Hospital from December 2017 and February 2019 were collected. There were 2 males and 2 females. The children were aged 11 days, 7 days, 5 days, and 3 years, respectively. The children underwent magnetic compression anastomosis. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect food intake and complications of children up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Results (1) Surgical and postoperative situations: four children underwent magnetic compression anastomosis successfully. Of the 4 children, 3 with esophageal atresia underwent open tracheoesophageal fistula repair and endoscope-assisted magnetic compression anastomosis, and 1 with congenital esophageal stenosis underwent endoscopic gastrostomy combined with magnetic compression anastomosis. The operation time of 4 children was (2.3±0.9)hours. The length of esophageal blind ending in the 3 children with esophageal atresia and length of esophageal stenosis were in the children with esophageal stenosis 30-35 mm and 8 mm. Four children has good magnet apposition, and time of postoperative magnet removal was (29±10)days. Three children with esophageal atresia had oral removal of magnet, and 1 with esophageal stenosis had magnet removed by gastrostomy. One child complicated with postoperative fistula and anastomotic stenosis was cured by unobstructed drainage and nutritional support treatment. The duration of postoperative hospital stay was (39±10)days. (2) Follow-up: 4 patients were followed up for 3-17 months, with a median time of 10 months, and restored to oral intake after oral removal of magnet and removal of magnet by gastrostomy on the days 14-36 postoperatively. One child was detected anastomotic stenosis by esophagography at the postoperative 3 months, and was improved after esophageal dilatation. The other 3 children recovered to normal connectivity of esophagus postoperatively and maintain unobstructed. Four children had normal eating, without dysphagia or other serious complications. Conclusion Magnetic compression anastomosis is safe and feasible for congenital esophageal atresia and stenosis, with good short-term efficacy. Key words: Congenital esophageal atresia; Congenital esophageal stenosis; Magnetics; Surgical instruments; Anastomosis

Button batteries (BBs) are commonly found in many household items and present a risk of severe injury to children if ingested. The direct apposition of the trachea and recurrent laryngeal nerves with the esophagus puts children at risk of airway injury secondary to the liquefactive necrotic effects of BB impactions. To review airway injuries, including long-term sequelae, after BB ingestion in children. For this systematic review, a comprehensive strategy was designed to search MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL (Cumulative Index of Nursing and Allied Health Literature) from inception to July 31, 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Additional cases were identified from the National Capital Poison Center BB registry. Individual authors were contacted for additional information. Studies with pediatric patients (<18 years) who developed airway injuries after BB ingestion were included. A total of 195 patients were included in the analysis; 95 were male. The mean (SD) age at BB ingestion was 17.8 (10.2) months. The mean (SD) time from BB ingestion to removal was 5.8 (9.0) days. The 2 most common airway sequelae observed in our series were 155 tracheoesophageal fistulae and 16 unilateral vocal cord paralyses. Twenty-three children had bilateral vocal cord paralysis. The mean (SD) duration of ingestion leading to vocal cord paralysis was shorter than that of the general cohort (17.8 [22.5] hours vs 138.7 [216.7] hours, respectively). Children presenting with airway symptoms were likely to have a subsequent tracheoesophageal fistula or vocal cord paralysis. Airway injuries are a severe consequence of BB ingestion, occurring more often in younger children. This systematic review found that tracheoesophageal fistulae and vocal cord paralyses were the 2 most common airway injuries, often requiring tracheostomy. Vocal cord injury occurred after a shorter BB exposure time than other airway injuries. Continued efforts should be directed toward prevention strategies to avoid the devastating sequelae of BB-associated airway injury.

To propose a gastrointestinal bleeding management algorithm that incorporates an endoscopic and imaging scoring system and specifies management of vascular complication from button battery ingestion. Button batteries (BB) are found in many electronic devices and ingestions are associated with serious complications especially in cases of unwitnessed ingestions, prolonged impaction, and in children less than 5years of age. Gastrointestinal bleeding from BB related vascular injury is rare but often rapidly fatal, with a mortality rate as high as 81%. There are no evidence-based guidelines for managing vascular complications from button battery ingestions. This paper proposes a management algorithm that 1) incorporates both an endoscopic and imaging scoring system to guide initial, post procedure, and discharge care and 2) specifies management of button battery related vascular bleeding. The endoscopic score is a modified Zargar classification with added categories for suspected aneurysm and tracheoesophageal fistula. Surgical and endovascular interventions for vascular injury are also reviewed. Until evidence-based guidelines can be developed, hospitals should have a multidisciplinary protocol based on institutional expertise to rapidly manage BB related vascular injury. Prevention of BB related injury offers the best hope of preventing serious complications and should include increasing public awareness and improving safety standards by working with industry and government.