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Management and Outcomes of Button Batteries in the Aerodigestive Tract: A Multi-institutional Study
Amber D Shaffer1,2, Ian N Jacobs3, Craig S Derkay4
1Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Button battery impaction in children's aerodigestive tracts is a surgical emergency. Urgent removal is crucial to prevent severe complications like esophageal strictures or nasal necrosis.
Area of Science:
- Pediatric Otolaryngology
- Emergency Medicine
- Pediatric Surgery
Background:
- Button battery ingestion is a common pediatric emergency.
- The aerodigestive tract is a frequent site for button battery impaction.
- Prompt recognition and management are vital to minimize morbidity.
Purpose of the Study:
- To delineate the clinical presentation of button battery impactions in the pediatric aerodigestive tract.
- To describe current management strategies and associated complications.
- To emphasize the urgency of intervention for impacted button batteries.
Main Methods:
- Retrospective, multi-institutional case series.
- Inclusion of 81 pediatric patients with button batteries in the aerodigestive tract (January 2002-December 2014).
- Review of battery characteristics, impaction location, symptoms, treatment, and outcomes.
Main Results:
- Esophageal impactions (n=48) were commonly associated with 3-V, 20-mm lithium batteries, leading to strictures, perforations, and fistulas.
- Nasal cavity impactions (n=22) resulted in necrosis, septal perforations, and saddle nose deformities.
- Duration of impaction correlated with persistent symptoms in nasal cases (P=.049).
Conclusions:
- Button batteries lodged in the pediatric aerodigestive tract constitute a surgical emergency.
- Urgent removal is paramount to prevent severe, potentially life-altering complications.
- Vigilant monitoring for delayed complications is essential post-removal.
Objectives/Hypothesis:
To describe the clinical presentation, management, and complications associated with button battery impaction in the aerodigestive tract in children.
Study Design:
Retrospective case series.
Methods:
This multi-institutional study, endorsed by the American Society of Pediatric Otolaryngology research consortium, is a retrospective medical record review, including all children at five tertiary-care institutions presenting with button batteries impacted in the aerodigestive tract between January 2002 and December 2014. Battery type/size, duration and location of impaction, presenting symptoms, treatment, complications, and outcomes were examined.
Results:
Eighty-one patients were included (64.2% male), with ingestion witnessed in 20 (24.7%). Median age at presentation was 3 years (range, 1 week-14 years). Median time from diagnosis to removal was 2.5 hours (range, 0.4-72 hours). Locations included the esophagus (n = 48), hypopharynx (n = 1), stomach (n = 6), nasal cavity (n = 22), and ear canal (n = 4). Most common symptoms for esophageal/hypopharyngeal impactions included dysphagia (26.5%), nausea/vomiting (26.5%), drooling (24.5%), cough (18.4%), and fever (18.4%). Most common symptoms for nasal impactions included epistaxis (54.6%), rhinorrhea (40.9%), nasal pain (27.3%), and fever (22.7%). Almost all esophageal impactions were from 3-V (89.5%), 20-mm (81.8%) lithium batteries. Severe esophageal complications included stricture (28.6%), perforation (24.5%), tracheoesophageal fistula formation (8.2%), pneumothorax (4.1%), and bilateral true vocal fold paresis (4.1%). Nasal complications included necrosis (59.1%), septal perforation (27.3%), and saddle nose deformity (4.5%). Duration of impaction correlated with an increased likelihood of persistent symptoms only for nasal batteries (P = .049).
Conclusions:
Button batteries in the upper pediatric aerodigestive tract or ear canal should be considered a surgical emergency, requiring urgent removal and careful vigilance for complications.
Level Of Evidence:
4 Laryngoscope, 131:E298-E306, 2021.
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