A 2-Year-Old Boy Who Developed an Aortoesophageal Fistula After Swallowing a Button Battery, Managed Using a Novel Procedure with Vascular Plug Device as a Bridge to Definitive Surgical Repair

Abstract

Patient: Male, 2-year-old Final Diagnosis: Aortoesophageal fistula Symptoms: Esophageal foreign body • gastrointestinal bleeding Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Pediatrics and Neonatology Objective: Rare disease Background: Button batteries (BBs) can be inhaled or swallowed accidentally, particularly by infants and children, who can present as a surgical emergency with a fatal outcome. This report is of a case of a 2-year-old boy who developed an aortoesophageal fistula (AEF) after swallowing a button battery and was successfully treated using a novel vascular plug device as a bridge to definitive surgical repair. AEF is diagnosed using computed tomography angiography (CTA), after laparotomy, and using aortography. Aortic endovascular stenting and vascular occluder placement is a minimally invasive emergency option until definitive treatment can be provided. The surgical options include repair the aortic defect primarily, or the diseased segment of the aorta is replaced with a graft. Case Report: A 2-year-old boy presented with hematemesis 9 days after ingestion of a button battery, which was removed endoscopically 16 hours after the incident. The patient was resuscitated aggressively and diagnosed to have AEF using computed tomography angiography (CTA). The aorta was successfully repaired using a vascular plug device, which kept the patient safe until the definitive surgical treatment was done 2 months later. The defect was repaired with direct anastomosis and completed with a patch of bovine pericardium, as well as closure of the fistula from the esophageal side with stitches. Conclusions: This report presents a rare but previously reported complication of swallowing a button battery, resulting in an aortoesophageal fistula. The aorta was successfully repaired using a vascular plug as a minimally invasive emergency option, which is considered as a lifesaving procedure and a bridge for definitive repair.

Management of oesophageal impaction of button batteries in Queensland

“…Children rarely survive an aorto‐oesophageal fistula and survival relies on access to cardiopulmonary bypass or ECMO, although novel endovascular techniques have also been described. A literature review of cases that have survived an aorto‐oesophageal fistula by Al Khatrawi et al ., reports five patients which were secondary to button battery ingestion 27 . Occult OBBI can mimic many other paediatric conditions with common non‐specific symptoms such as reduced intake, vomiting, cough, fever.…”

“…A literature review of cases that have survived an aorto-oesophageal fistula by Al Khatrawi et al, reports five patients which were secondary to button battery ingestion. 27 Occult OBBI can mimic many other paediatric conditions with common non-specific symptoms such as reduced intake, vomiting, cough, fever. Epistaxis, a common presentation is children could also represent an upper gastrointestinal bleed or a BB impacted in the nose.…”

Diagnosis and Management of Button Battery Ingestion Complicated by Tracheo-Esophageal and Aorto-Esophageal Fistulas

“…Severe complications usually occur when button batteries remain lodged into the esophagus, a condition that can potentially lead to ulceration, perforation, and fistulization with surrounding tissues. BBI complications include pneumonia, mediastinitis, hemorrhage, esophageal ulceration and perforation, sepsis, tracheoesophageal fistula, and aorto-esophageal fistula [ 7 ].…”

“…The diagnosis was made by CTA in six cases, angiogram in two cases, and during the operation in one patient. AEF was surgically repaired in seven patients and treated by endovascular approach in three cases [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ].…”