Chronic stridor in a toddler after ingestion of a discharged button battery: a case report

Abstract

Background Button battery (BB) ingestions (BBI) are increasingly prevalent in children and constitute a significant, potentially life-threatening health hazard, and thus a pediatric emergency. Ingested BBs are usually charged and can cause severe symptom within 2 h. Discharged BBs ingestion is very rare and protracted symptom trajectories complicate diagnosis. Timely imaging is all the more important. Discharged BBs pose specific hazards, such as impaction, and necessitate additional interventions. Case presentation We present the case of a previously healthy 19-month-old girl who was admitted to our pediatric university clinic in Germany for assessment of a three-month history of intermittent, mainly inspiratory stridor, snoring and feeding problems (swallowing, crying at the sight of food). The child’s physical examination and vital signs were normal. Common infectious causes, such as bronchitis, were ruled out by normal lab results including normal infection parameters, negative serology for common respiratory viruses, and normal blood gas analysis, the absence of fever or pathological auscultation findings. The patient’s history contained no evidence of an ingestion or aspiration event, no other red flags (e.g., traveling, contact to TBC). Considering this and with bronchoscopy being the gold standard for foreign body (FB) detection, an x-ray was initially deferred. A diagnostic bronchoscopy, performed to check for airway pathologies, revealed normal mucosal and anatomic findings, but a non-pulsatile bulge in the trachea. Subsequent esophagoscopy showed an undefined FB, lodged in the upper third of the otherwise intact esophagus. The FB was identified as a BB by a chest X-ray. Retrieval of the battery proved extremely difficult due to its wedged position and prolonged ingestion and required a two-stage procedure with consultation of Ear Nose Throat colleagues. Recurring stenosis and regurgitation required one-time esophageal bougienage during follow-up examinations. Since then, the child has been asymptomatic in the biannual endoscopic controls and is thriving satisfactorily. Conclusion This case describes the rare and unusual case of a long-term ingested, discharged BB. It underscores the need for heightened vigilance among healthcare providers regarding the potential hazards posed by discharged BBIs in otherwise healthy children with newly, unexplained stridor and feeding problems. This case emphasizes the critical role of early diagnostic imaging and interdisciplinary interventions in ensuring timely management and preventing long-term complications associated even to discharged BBs.

Esophageal button battery impactions in children: An analysis of 89 cases

“…Common clinical presentations of BB impactions include vomiting, dysphagia, pain, drooling, cough, and fever, while rare manifestations may include unexplained crying, hoarseness, laryngeal stridor, dyspnea, and melena. Interestingly, some cases may present with no obvious discomfort [9] . Contrary to the European Society of Pediatric Button Battery Ingestion in Childhood guidelines [10] , which emphasize drooling and vomiting as major symptoms, our study found that vomiting and dysphagia were predominant complaints.…”

“…Esophageal stenosis and perforation were the most common complications observed in our study, and tracheoesophageal stula should be considered when symptoms such as fever and cough occur after the operation. Fortunately, most children with complications can heal spontaneously without surgery [9,18,19] . Following the operation, patients were fed via gastric tube, and active anti-infection, acid inhibition, and symptomatic treatment were administered for a week.…”