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[Tracheoesophageal fistula secondary to ingestion of a button battery]
M Peralta1, B Fadda, L Contreras
1Servicio de Pediatría, Hospital Carlos van Buren de Valparaíso.
Insights
Button-sized electric cells ingested by infants can cause rapid esophageal necrosis and perforation. Immediate endoscopic extraction is crucial to prevent potentially lethal complications like pneumonia and fistulae.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Emergency Medicine
Background:
- Button-sized electric cells, commonly found in small electronic devices, pose a significant ingestion risk to infants.
- Accidental ingestion can lead to severe esophageal injury due to leakage of alkaline electrolytes.
Observation:
- An 11-month-old infant presented with fever, cough, and vomiting after ingesting an electric cell from a wristwatch.
- Initial X-ray revealed an esophageal foreign body, successfully removed via endoscopy.
- Despite initial improvement, the infant developed respiratory distress, pneumonia, and anemia, leading to death.
Findings:
- Necropsy revealed a large esophageal perforation communicating with the trachea.
- Esophageal wall necrosis and perforation can occur within 4-12 hours of electric cell impaction.
- Severe bilateral pneumonia was confirmed as a contributing factor to mortality.
Implications:
- Emergency room staff must maintain a high index of suspicion for esophageal electric cell ingestion.
- Prompt endoscopic evaluation and extraction are critical to prevent life-threatening complications.
- Preventive measures, including restricting infant access to battery-operated devices, are essential.
Abstract:
An eleven month old girl was admitted to a county hospital because of persistent low grade fever, cough, vomitus and food and oral fluids rejection. A small radiopaque, button sized, round object was seen impacted in the upper esophageal third on X ray examination and later extracted by endoscopy, corresponding to an electric cell, from a father's handwatch, which had been ingested by the baby without knowledge of parents about 30 h before. After 12 h fasting, oral feedings were resumed being apparently well tolerated, but in the following day fever and respiratory distress reappeared, together with drooling, cianosis, abdominal distention and pale skin. Patient was transferred to a regional hospital where extensive bilateral pneumonia and anemia were documented. Gastric drainage via nasogastric tube, antibiotic treatment, blood transfusion and oxygen therapy were given from admission, but she died within a few hours. At necropsy a 3 per 2.5 cm diameter orifice of sharp borders was seen in the upper third of the esophagus, communicating to tracheal lumen through its upper six cartilages. Extensive, severe, bilateral pneumonia was confirmed. When this kind of electric cells become impacted into the esophagus, wall necrosis may occur within 4 h and perforation within 8 to 12 h and can be prevented by immediate endoscopic extraction. Otherwise fistulae should be suspected and patients managed accordingly. Emergency room medical staff must always be aware of this potentially lethal condition and its proper management. Infants should not be permitted to play with such apparently innocent objects as battery operated handwatches.