Button battery removed from the stomach resulting in a missed aortoesophageal fistula – a multidisciplinary approach to rescuing a very young patient: a case report

Granata, Antonino; Gandolfo, Caterina; Acierno, Carlo; Piazza, Marcello; Burgio, Gaetano; Traina, Mario

doi:10.1186/s13256-018-1818-5

Cited by 21 publications

(9 citation statements)

References 12 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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“…Percutaneous endovascular aortic repair (EVAR) using balloon expandable stents is used in pediatric patients. Three patients have been reported to survive [ 15 , 20 ], while in one patient with mycotic aneurysms, the definitive surgical treatment was delayed, leading to death of the patient 3 months after stent placement [ 35 ]. In adult studies, EVAR should be considered only as a temporizing strategy until definitive repair can be performed [ 45 ].…”

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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“…Although endovascular aortic repair for an AEF is less invasive and has been reported in adults, to date, there remains only one report in a pediatric-aged patient. [ 23 20 ] Postoperatively, the patient should be monitored in a critical care setting as the ongoing alkali damage may continue for days to weeks.…”

Section: Discussionmentioning

confidence: 99%

Successful management of an aorto-esophageal fistula following button battery ingestion

Wakimoto

Willer

McKee

et al. 2021

Saudi Journal of Anaesthesia

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Foreign body ingestion is a common event among pediatric patients, especially in children less than 6 years of age. Although most cases are relatively benign, with the foreign body passing spontaneously or requiring a brief endoscopic procedure for removal, button battery ingestion is known to cause significant morbidity with the potential for mortality. Although aorto-esophageal fistula (AEF) is a rare complication following button battery ingestion, its clinical manifestations are significant and outcomes are poor. Early diagnosis and aggressive treatment are key in preventing fatal complications. We describe the successful management of an AEF which presented with hematemesis 8 days after removal of a button battery in a 17-month-old female. The literature regarding button battery ingestion and AEF is reviewed and treatment options including intraoperative anesthetic care discussed.

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Button battery removed from the stomach resulting in a missed aortoesophageal fistula – a multidisciplinary approach to rescuing a very young patient: a case report

Cited by 21 publications

References 12 publications

Current management of button battery injuries

Current management of button battery injuries

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

Successful management of an aorto-esophageal fistula following button battery ingestion

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