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Esophageal Retained Lithium Battery in Children Younger than 6 Years: A Prompt Structured Multidisciplinary Approach
Gabriele Lisi1, Maria Teresa Illiceto2, Erminia Francesca Romeo3
1From the Pediatric Surgery Unit-University "G. d'Annunzio" of Chieti-Pescara.
Insights
Lithium battery ingestion in children is a medical emergency. Surgical removal after failed endoscopy can be necessary, but carries risks of severe esophageal complications like stenosis and fistulas.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
- Emergency Medicine
Background:
- Esophageal retention of disk batteries in young children is a growing concern.
- It poses a significant risk of life-threatening complications.
- Surgical intervention following failed endoscopic removal is infrequently documented.
Purpose of the Study:
- To report on the surgical management of esophageal disk battery retention in pediatric patients.
- To highlight the challenges and outcomes of this rare clinical scenario.
Main Methods:
- Two pediatric patients with retained lithium batteries underwent failed endoscopic removal.
- Surgical extraction via cervical esophagotomy was performed.
- Esophageal repair was conducted over a feeding tube.
Main Results:
- One patient developed severe esophageal stenosis and a tracheoesophageal fistula, requiring conservative management and stenting.
- The second patient had asymptomatic, limited esophageal stenosis.
- Surgical intervention was required due to fused batteries and failed endoscopic attempts.
Conclusions:
- Emergent management of lithium battery ingestion necessitates a multidisciplinary approach.
- Involvement of experienced pediatric endoscopists and surgeons is crucial.
- Minimizing esophageal exposure to battery current is key to preventing severe tissue damage and improving prognosis.
Objectives:
Disk battery esophageal retention in children younger than 6 years represents an increasing endoscopic emergency, followed by a relevant risk of life-threatening late complications. Surgical removal after a failed endoscopic approach is rarely reported in the literature. We describe our experience in this scenario.
Methods:
Two female asymptomatic patients aged 26 and 29 months presented within 4 hours after a witnessed ingestion of a 2-cm, 3-V lithium battery (CR2032) retained in the cervical esophagus. Both patients underwent a prolonged unsuccessful emergent endoscopic removal with a flexible instrument performed by an adult gastroenterologist. Both batteries fused with the esophageal wall were extracted through a longitudinal left cervical esophagotomy combined with minimal resection of necrotic tissues and repaired over a 12F feeding tube.
Results:
Patients were extubated after 12 and 72 hours, respectively. Contrast study was performed after 20 and 13 days, respectively, before resuming oral feeding. At endoscopy, the first patient developed a 3-cm-long severe esophageal stenosis (35th day), followed by an asymptomatic tracheoesophageal fistula (60th day), which was conservatively treated. After spontaneous resolution of the tracheoesophageal fistula, esophageal stenosis progressed, partially responsive to esophageal stenting. Short esophagectomy is under evaluation. The second patient developed an asymptomatic limited stenosis, not requiring dilatation.
Conclusions:
The emergent management of lithium battery ingestion needs a structured timely multidisciplinary approach in the emergency department, an experienced pediatric endoscopist, and a simultaneous engagement of pediatric surgical expertise, even in patients who do not show bleeding, to reduce esophageal exposure time to high-voltage current released by batteries, which represents the main factor conditioning tissue damage and prognosis.
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