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Pediatric esophageal diverticulum following button batter ingestion. A case report
Kennedy Kisengo Misso1, Sengua Koipapi1, Kondo Chilonga1
1Department of General Surgery, Kilimanjaro Christian Medical Centre, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical University College, Tanzania.
Insights
Button battery ingestion in children can cause serious esophageal damage. Early diagnosis and endoscopic retrieval are vital for effective management and preventing complications like diverticula.
Area of Science:
- Pediatric Gastroenterology
- Foreign Body Ingestion Management
- Esophageal Injury
Background:
- Foreign body ingestion is common in children, with button batteries posing significant risks due to their chemical and mechanical impact.
- Esophageal lumen injury from ingested objects is a critical concern, necessitating prompt medical attention.
Observation:
- A two-year-old girl presented with dysphagia, weight loss, and recurrent chest infections.
- Radiographic findings showed a 'halo sign' in the thoracic esophagus, indicative of a foreign body.
- Severe esophageal inflammation complicated esophagoscopy, leading to thoracotomy for diagnosis and management.
Findings:
- The surgical exploration revealed an esophageal diverticulum, which was successfully managed conservatively.
- The patient recovered well, resuming normal feeding and experiencing resolution of chest symptoms post-operatively.
- Esophageal diverticula are a rare complication of button battery ingestion.
Implications:
- This case highlights the potential for serious esophageal complications from button battery ingestion.
- Prompt diagnosis and intervention, prioritizing less invasive endoscopic retrieval, are crucial for optimal outcomes.
- Raising awareness about button battery ingestion risks and management strategies is essential for pediatric healthcare providers.
Introduction And Significance:
Foreign body ingestion is a frequent and potentially life-threatening concern in children, with button batteries being the second most frequently ingested object trailing coins. The mechanical and chemical impact of foreign objects on delicate esophageal lumen poses a grave concern.
Case Presentation:
Herein, we unveil a compelling case of a two-year-old girl who suffered from difficulty in swallowing, weight loss, and frequent chest infections. A chest X-ray revealed a halo sign within the confines of her thoracic esophagus. However, the formidable challenge of extensive inflammation greatly hindered visibility during esophagoscopy, leading to an imperative decision of thoracotomy. The surgical exploration uncovered an esophageal diverticulum, skillfully managed with a conservative approach. Three months postoperatively, she resumed regular feeds without chest symptoms.
Discussion:
Foreign body ingestion is predominantly among children below four years, with button batteries being among the frequent objects involved. Endoscopic retrieval is an effective and less morbid procedure for foreign body retrieval. Esophageal diverticula following button battery ingestion have rarely been reported.
Conclusion:
Timely diagnosis and effective management of esophageal foreign bodies are crucial, as chemical reactions from button batteries can commence within two hours of ingestion. Swift and decisive actions, coupled with less morbid procedures such as endoscopic retrieval should be prioritized in the management.
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