Treatment of burn complications in the esophagus caused by button batteries in children (a literature review)

Abstract

Introduction. Over the past 10 years, the number of severe and fatal cases of burns in the esophagus caused by button batteries in children has increased significantly. The tactics of managing children with complications after such burns has not been defined worldwide yet; few clinical cases are described in Russian sources. Material and methods. The literature search has covered databases of RSCI, Medline and GoogleScholar published in 1983–2022. More than 350 publications on this topic have been analyzed. Results. Electrolysis is recognized as the main mechanism of tissue destruction, which is accompanied by the development of colliquative necrosis in the area of negative pole of the battery. The National Capital Poison Center, Washington, USA, recommends to neutralize burns with honey and 0.25 % acetic acid solution. The most optimal tactics for managing tracheoesophageal fistulas caused by batteries is to perform laparoscopic fundoplication and gastrostomy, as a result of which spontaneous closure of the fistula may occur. In case of large defects and patient’s severe unstable condition more complicated reconstructive interventions have to be done. Esophageal stenoses should be treated with bougienage, and perforations are preferably treated conservatively. In case of laryngeal paresis or paralysis, laryngoscopy is required at the early stage so as to understand if tracheostomy is better instead of tracheal intubation. Esophageal aortic fistulas require aggressive surgical tactics even in the absence of visible bleeding. Conclusion. Currently, there is no common management strategy in any of the possible complications. Further statistical analysis of clinical cases and assessment of existing conservative and surgical techniques are needed; development of new surgical techniques to be applied in patients with abovementioned pathology is needed as well. Rational diagnostics and curative tactics will reduce high mortality rate and improve the quality of life of such patients.