A Near Miss and Salvage Management of Aortoesophageal Fistula Secondary to Cell Battery Ingestion

Bartkevics, Maris; Stanković, Zoran; Schibli, Susanne; Fluri, Simon; Berger, Steffen; Schmidli, Juerg; Kadner, Alexander

doi:10.1177/2150135119880549

Cited by 12 publications

(4 citation statements)

References 4 publications

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“…A key presenting symptom in these patients is hematemesis and clinicians must evaluate this further in patients with a history of BB ingestion at risk for delayed aortoesophageal fistula (AEF). AEF is nearly always fatal with only six reported cases of survival after BB ingestion, all of whom were 3 years of age or younger, had hematemesis after removal, and for the most part, had unknown duration of BB exposure 52–56 . In one large retrospective study, the cause of death was unknown in over half of the fatalities associated with BB ingestion with the remaining deaths attributed to arterial fistulization and bronchopneumonia 21 .…”

Section: Clinical Considerationsmentioning

confidence: 99%

Current management of button battery injuries

Sethia

Gibbs

Jacobs

et al. 2021

Laryngoscope Investig Oto

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Button batteries (BB) are found in common household items and can lead to significant morbidity and mortality in the pediatric population when ingested. BBs are made of various chemistries and have a unique size and shape that yield significant injury when lodged in the pediatric esophagus. BBs create a local tissue pH environment of 10 to 13 and can induce liquefactive necrosis at the negative pole. This initial injury can progress with further tissue breakdown even after removal. Unfortunately, patients may present with vague symptoms similar to viral illnesses and there is not always a known history of ingestion. Plain film X‐ray can be diagnostic. Exposure can lead to caustic injury within 2 hours. Thus, timely endoscopic removal is the mainstay of treatment. Novel mitigation and neutralization strategies have been implemented into treatment guidelines. These include the preremoval ingestion of honey or sucralfate and intraoperative irrigation with acetic acid. Depending on the severity of injury following removal, careful consideration should be given for potential delayed complications including fistulization into major vessels which often leads to death. The National Button Battery Taskforce and several industry members have implemented prevention strategies such as educational safety outreach campaigns, child‐resistant packaging changes, and warning labels. Governmental regulation and industry changes are key to limit not only the amount of BB ingestions, but also the devastating consequences that can result. Anonymous reporting of BB injuries through the Global Injury Research Collaborative has been made convenient and centralized through the advent of a user‐friendly smartphone iOS/App Store and Android/GooglePlay application called the “GIRC App”; all specialists who manage foreign body cases should contribute their cases to help prevent future injuries. BB ingestion must be recognized and treated promptly using a multidisciplinary approach to optimize outcomes for these patients. Ultimately, a safer BB technology is critically needed to reduce or eliminate the severe and life‐threatening injuries in children. Level of Evidence 5

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Section: Clinical Considerationsmentioning

confidence: 99%

Current management of button battery injuries

Sethia

Gibbs

Jacobs

et al. 2021

Laryngoscope Investig Oto

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Button battery ingestion (BBI) is common in children and its prevalence has increased in the last decades. BBI can be responsible for very severe and potentially fatal complications if not promptly detected. We describe the successful management of two cases of BBI that occurred in two previously healthy infants. Both patients presented with vague symptoms and no witness of foreign body ingestion. The prolonged time of exposure to the corrosive effects of disk batteries was responsible for the development of tracheo-esophageal fistula (TEF) and aorto-esophageal fistula (AEF). We demonstrate how prompt diagnosis and management are crucial for the infants’ survival.

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“…This is because of the different aetiologias in pediatric and adult patients; the most common cause in adults is thoracic aortic aneurysm, which is rare among children. Endoscopy findings varied in reported cases, and included pulsatile or fresh bleeding [ 11 , 12 , 40 ], pulsatile submucosal hematoma [ 44 ], a non-pulsatile purple mass protruding into the esophagus in the aneurysm [ 36 ], esophageal ulcer with [ 18 ] or without bleeding [ 13 ], thickened mucosa [ 21 ], and an odd purple streak [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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A Near Miss and Salvage Management of Aortoesophageal Fistula Secondary to Cell Battery Ingestion

Cited by 12 publications

References 4 publications

Current management of button battery injuries

Current management of button battery injuries

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

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

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