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Button battery ingestion in pediatric populations is a common occurrence with severe sequelae. Multiple case reports have established the occurrence of death, fistula formation, mucosal erosion, esophageal perforation, and bleeding post-ingestion of button batteries. However, there is a gap in the literature on the occurrence of bilateral vocal cord paralysis post-lithium battery ingestion. We present a case in which a 12-month-old male developed bilateral vocal cord paralysis following ingestion of a button battery. We compare our case to eleven other reports that exist in the literature based on age, sex, time until removal, clinical presentation, day upon which vocal cord paralysis developed, anatomic location, and post-operative course. We conclude that bilateral vocal cord paralysis is a time-sensitive complication which requires prompt diagnosis. Any child with stridor following button battery ingestion should undergo consultation with pediatric otolaryngology immediately. In addition, long-term follow-up is necessary to evaluate return of normal vocal cord function. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of pediatric button battery (BB) ingestions has increased in recent years with a subsequent rise in secondary esophageal injuries. There is a paucity of published literature on the evaluation and management of acquired trachea-esophageal fistulas (TEF) in this context and therefore, the purpose of this paper was to summarize a case and propose an evidence-based protocol for acquired TEF management. Case presentation: A 15-month-old female presenting with fever, mild tachypnea and lethargy underwent a chest x-ray which demonstrated a BB in the upper thorax. Laryngoscopy, and subsequent rigid esophagoscopy, identified the BB in the proximal esophagus. There was surrounding inflammation and liquefactive necrosis, and the BB was removed via rigid esophagoscopy. A post-procedure chest computerized tomography following BB removal revealed a small collection in the mediastinum consistent with full thickness esophageal perforation as well as mediastinitis. She was treated conservatively and on post-operative day (POD) 7, a swallow study demonstrated no evidence of leak or stricture, thus a trial of oral, clear fluids took place. A next-day repeat swallow study was performed and revealed an acquired TEF. She was treated conservatively with proton pump inhibitor and nasojejunal feeds. Bronchoscopy, upper gastrointestinal endoscopy and repeat esophagram at six-weeks demonstrated resolution of the TEF. Conclusion: Clinicians should have a high index of suspicion for BB ingestion complications, even after removal. This case illustrated that patients with acquired TEF can be managed conservatively. Following literature review and our personal experience in this single case, we propose a suggested algorithm for management of these patients.

Open in new tab Download slide OBJECTIVES In recent years, an increase in severe and even fatal outcomes related to oesophageal or airway button battery (BB) ingestion by infants and small children has been reported. Extensive tissue necrosis caused by lodged BB can lead to major complications, including tracheoesophageal fistula (TEF). In these instances, best treatment remains controversial. While small defects may warrant a conservative approach, surgery often remains inevitable in highly complex cases with large TEF. We present a series of small children that underwent successful surgical management by a multidisciplinary team in our institution. METHODS This is a retrospective analysis of n  = 4 patients <18 months undergoing TEF repair from 2018 to 2021. RESULTS Surgical repair under extracorporeal membrane oxygenation (ECMO) support was feasible in n  = 4 patients by reconstructing the trachea with decellularized aortic homografts that were buttressed with pedicled latissimus dorsi muscle flaps. While direct oesophageal repair was feasible in 1 patient, 3 required esophagogastrostomy and secondary repair. The procedure was completed successfully in all 4 children with no mortality and acceptable morbidity. CONCLUSIONS Tracheo-oesophageal repair after BB ingestion remains challenging and is associated with major morbidity. Bioprosthetic materials in conjunction with the interposition of vascularized tissue flaps between trachea and oesophagus appear to be a valid approach to manage severe cases. [ABSTRACT FROM AUTHOR]

Abstract Background Accidental swallowing of a foreign body occurs more frequently in children than in adults. Among these cases, button battery impaction in the esophagus may cause severe complications. While prevention is always ideal, if button battery impaction is suspected, immediate diagnosis and retrieval are important. Case presentation We introduce a novel method for retrieval of a button battery after ingestion by a 2.5-year-old child. When the patient arrived at our center, the battery was incarcerated in the upper esophagus. The battery could not be removed, despite the use of several methods such as alligator forceps under endoscopy and net retrieval. We decided to use a novel method that combined endoscopic balloon extraction and forceps retrieval. This resulted in a push-and-pull effect, creating synergy and easy removal of the battery. There were no long term complications based on the follow-up endoscopy examination. Conclusions This new procedure was very effective for removing the esophageal foreign body. When button battery in esophagus was too tight to be removed by the traditional retrieval methods, this procedure was suggested to use. It could be performed at medical institutions. If it fails or esophageal perforation (iatrogenic or spontaneous) occurs, pediatric surgeons could take over immediately.

This case report describes a 17-month-old child with ingestion of a button battery. The clinical presentation, diagnostic reasoning, national guidelines, hospital course, and follow-up are discussed. Between 1995 and 2015, an estimated 759,074 children aged < 6 years were seen in emergency departments for suspected or confirmed foreign body ingestions, representing a 93.3% increase in cases. The most common objects ingested were coins, toys, jewelry, and batteries. The most common battery ingested was a button battery. Although 80% to 90% of ingested foreign objects pass without intervention, a button battery positioned in the esophagus is an emergency requiring immediate removal. [ABSTRACT FROM AUTHOR]

Button battery ingestion is a form of foreign-body ingestion usually seen among children. Its ingestion could be symptom free and sometimes fatal. The interval between swallowing and final destination of the button battery has some clinical importance to its management. This is a case report of an eight-year-old boy, who ingested a 25 mm-sized button battery which was detected in the lower esophagus by a plain X-ray, managed conservatively with honey, and was later passed out of stool after 36 h.

Foreign body ingestion is a common event among pediatric patients, especially in children less than 6 years of age. Although most cases are relatively benign, with the foreign body passing spontaneously or requiring a brief endoscopic procedure for removal, button battery ingestion is known to cause significant morbidity with the potential for mortality. Although aorto-esophageal fistula (AEF) is a rare complication following button battery ingestion, its clinical manifestations are significant and outcomes are poor. Early diagnosis and aggressive treatment are key in preventing fatal complications. We describe the successful management of an AEF which presented with hematemesis 8 days after removal of a button battery in a 17-month-old female. The literature regarding button battery ingestion and AEF is reviewed and treatment options including intraoperative anesthetic care discussed.

Purpose: Institutions are adopting the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for pediatric esophageal button battery ingestion (EBBI). Our objective was to evaluate the guidelines' impact on in-hospital resource utilization and short-term clinical outcomes in hemodynamically stable patients after endoscopic battery removal. Methods: A single-center retrospective review of all EBBI admissions from 2010 to 2020. Patients were divided into two groups based on adoption of national guidelines: pre-guideline (2010–2015) and post-guideline (2016–2020). Results: Sixty-five patients were studied (pre-guideline n = 23; post-guideline n = 42). Compared with pre-guideline, post-guideline use of magnetic resonance imaging (MRI) increased (2/23 [8.7%]; 30/42 [71.4%]; p < 0.001). Post-guideline increases resulted for median days (IQR) receiving antibiotics (0 [0, 4]; 6 [3, 8]; p = 0.01), total pediatric intensive care unit admission (0 [0, 1]; 3 [0, 6]; p < 0.001), and total hospital length of stay (5 [2, 11]; 11.5 [4, 17]; p = 0.02). Two patients in the post-guideline group had delayed presentations despite normal imaging: one with TEF and one with aorto-esophageal fistula. All survived to discharge. Conclusion: In EBBI cases managed using the consensus based NASPHAGN guidelines, we report increased resource utilization without improved patient outcomes. Further research should evaluate post-guideline costs and resource utilization. [ABSTRACT FROM AUTHOR]

Background: Accidental swallowing of a foreign body occurs more frequently in children than in adults. Among these cases, button battery impaction in the esophagus may cause severe complications. While prevention is always ideal, if button battery impaction is suspected, immediate diagnosis and retrieval are important.Case Presentation: We introduce a novel method for retrieval of a button battery after ingestion by a 2.5-year-old child. When the patient arrived at our center, the battery was incarcerated in the upper esophagus. The battery could not be removed, despite the use of several methods such as alligator forceps under endoscopy and net retrieval. We decided to use a novel method that combined endoscopic balloon extraction and forceps retrieval. This resulted in a push-and-pull effect, creating synergy and easy removal of the battery. There were no long term complications based on the follow-up endoscopy examination.Conclusions: This new procedure was very effective for removing the esophageal foreign body. When button battery in esophagus was too tight to be removed by the traditional retrieval methods, this procedure was suggested to use. It could be performed at medical institutions. If it fails or esophageal perforation (iatrogenic or spontaneous) occurs, pediatric surgeons could take over immediately. [ABSTRACT FROM AUTHOR]

Button battery ingestion is potentially fatal, especially in children less than 6 years of age, most commonly due to esophageal perforation. The number of ingestions and complications has risen significantly in recent decades. Impacted button batteries should ideally be removed urgently within 2 hours of ingestion. However, many ingestions go unwitnessed, and children may present with variable, vague symptoms. The recommendation now is that children over the age 12 months consume honey when a button battery ingestion is witnessed or diagnosed, if less than 12 hours have elapsed. Importantly, though, honey should not be consumed if perforation is suspected. Induction of general anesthesia and battery removal should not be delayed to satisfy NPO guidelines, even if the child has eaten., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background: In pediatrics, foreign body ingestion poses unique challenges. Each case is unique given variability in timing, type, and size of object, compounded by underlying comorbidities and age. In the mid‐1990s, mortality and morbidity associated with button battery (BB) ingestion (BBI) emerged corresponding to modification in battery fabrication towards higher voltage, large‐diameter lithium cells. Aims: To describe the case and management of a BBI in a pediatric patient necessitating the use of cardiopulmonary bypass and deep hypothermic circulatory arrest (DHCA). Materials and Methods: A 17‐month‐old female presented with the sudden loss of consciousness at home. Chest X‐ray revealed an esophageal foreign body suspicious for BBI. A massive upper gastrointestinal bleeding was temporized with packing. The patient was urgently taken to the operating room for sternotomy, establishment of cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA), removal of BB, repair of the left common carotid artery, esophageal, and tracheal injuries. Discussion: Successful management of BBI requires coordinated care and a multidisciplinary approach. A high degree of clinical suspicion for BBI is imperative to facilitate early aggressive interventions. Lateral and anteroposterior chest films should be obtained in any suspected BBI. Conclusion: This case demonstrates the utility of CPB and DHCA where control of bleeding secondary to BBI is not otherwise possible. [ABSTRACT FROM AUTHOR]

This study reports on vocal cord paralysis caused by esophageal button battery (BB) ingestion in children. Medical records of children with vocal cord paralysis and esophageal BB ingestion treated at a tertiary referral institute between January 2016 and March 2020 were reviewed. Five patients aged 9–58 months were identified; three were male. Each patient had accidentally swallowed a 20-mm-diameter lithium battery (3 CR2032 type and 2 CR2025 type). One battery was removed within 4 h after ingestion, and three batteries were removed within 12 h. Removal of the battery was achieved with rigid esophagoscopy in four patients and direct laryngoscopy in one patient. Four patients had bilateral, and one had unilateral vocal cord paralysis. Three patients underwent tracheotomy; two were tracheotomy-dependent until follow-up, while the third patient died of multiple organ dysfunction syndrome a month after surgery. The two cases without tracheotomy remain under close follow-up. Conclusion: Accidentally ingested button batteries should be removed promptly to avoid severe complications. Respiratory support and neurotrophic treatment in the early stage of vocal cord paralysis may be beneficial for recovery of vocal cord movement. What is Known: • Button battery ingestion in children is extremely harmful, especially when the diameter of the button battery exceeds 20 mm. • Esophageal button battery impaction can cause serious complications such as esophageal perforation, mediastinal infection, tracheoesophageal fistula, vocal cord paralysis, and life-threatening bleeding. What is New: • Vocal cord paralysis in children with button battery ingestion plays an early warning role for identifying the severity of the disease. • Early neurotrophic drugs and glucocorticoid therapy may be helpful for the recovery of vocal cord movement, thereby avoiding tracheotomy. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is a common event among pediatric patients, especially in children less than 6 years of age. Although most cases are relatively benign, with the foreign body passing spontaneously or requiring a brief endoscopic procedure for removal, button battery ingestion is known to cause significant morbidity with the potential for mortality. Although aorto‑esophageal fistula (AEF) is a rare complication following button battery ingestion, its clinical manifestations are significant and outcomes are poor. Early diagnosis and aggressive treatment are key in preventing fatal complications. We describe the successful management of an AEF which presented with hematemesis 8 days after removal of a button battery in a 17‑month‑old female. The literature regarding button battery ingestion and AEF is reviewed and treatment options including intraoperative anesthetic care discussed. [ABSTRACT FROM AUTHOR]

The incidence of pediatric button battery (BB) ingestions has increased in recent years with a subsequent rise in secondary esophageal injuries. There is a paucity of published literature on the evaluation and management of acquired trachea-esophageal fistulas (TEF) in this context and therefore, the purpose of this paper was to summarize a case and propose an evidence-based protocol for acquired TEF management. A 15-month-old female presenting with fever, mild tachypnea and lethargy underwent a chest x-ray which demonstrated a BB in the upper thorax. Laryngoscopy, and subsequent rigid esophagoscopy, identified the BB in the proximal esophagus. There was surrounding inflammation and liquefactive necrosis, and the BB was removed via rigid esophagoscopy. A post-procedure chest computerized tomography following BB removal revealed a small collection in the mediastinum consistent with full thickness esophageal perforation as well as mediastinitis. She was treated conservatively and on post-operative day (POD) 7, a swallow study demonstrated no evidence of leak or stricture, thus a trial of oral, clear fluids took place. A next-day repeat swallow study was performed and revealed an acquired TEF. She was treated conservatively with proton pump inhibitor and nasojejunal feeds. Bronchoscopy, upper gastrointestinal endoscopy and repeat esophagram at six-weeks demonstrated resolution of the TEF. Clinicians should have a high index of suspicion for BB ingestion complications, even after removal. This case illustrated that patients with acquired TEF can be managed conservatively. Following literature review and our personal experience in this single case, we propose a suggested algorithm for management of these patients. [ABSTRACT FROM AUTHOR]

Background: Complications from esophageal button battery impactions remain a real fear for practicing pediatric gastroenterologists and surgeons. This case describes a child who developed an aorto-esophageal fistula 25 days after initial battery ingestion and survived due to prompt placement of an aortic stent via minimally invasive surgery, avoiding an open procedure. Case presentation: A 6-year-old female presented acutely with a mid-esophageal button battery impaction witnessed by her parents. Presenting symptoms included chest pain and emesis. Button battery location and size were confirmed on X-ray. She underwent removal with flexible esophagogastroduodenoscopy (EGD) and rigid esophagoscopy. She was admitted to the hospital and received conservative medical management, with serial cross-sectional imaging via chest MRIs to assess the evolution of her injury according to available national guidelines, and was discharged after 12 days of close inpatient monitoring. Despite these measures the patient re-presented 25 days post-ingestion with hematemesis from a new aorto-esophageal fistula, requiring emergent cardiac catheterization with successful, life-saving aortic stent placement. She remained admitted for an additional 12 days of monitoring as her diet was advanced slowly post-catheterization. Since this second hospitalization she continues to do well, with outpatient follow-up by multiple subspecialists. Conclusions: This case highlights the continued uncertainty regarding the risk of developing this complication, as well as gaps in the current literature and guidelines for managing these patients following ingestion and esophageal injury. It also details the unique course following development of this complication and its surgical repair.

Objective: The objective of the study is to test whether the use of edible oil might be an early treatment strategy for reducing button battery-induced esophageal injury.Methods: A button battery was inserted into esophageal segments collected from pigs. The esophageal segments were randomly allotted to one of the following six treatments: (1) untreated (nothing injected), (2) lemon juice, (3) orange juice, (4) colza oil, (5) peanut oil, and (6) olive oil. Every hour, the battery discharge and the pH value were measured in the esophageal tissue. After treatment for 6 h, the residual voltage of the battery was measured and the esophageal tissue was processed with H&E staining.Results: In esophageal segments of the untreated group, a large area of the mucous membrane was severely eroded. Partial erosion was observed in esophageal tissues treated with either lemon juice or orange juice. Furthermore, the esophageal tissues were basically intact, had little damage when treated with oils. The highest extra-esophageal discharge voltage was recorded in the untreated group, a medium amount of discharge voltage was recorded in the lemon juice and orange juice groups, and the lowest discharge voltage was recorded in all the edible oils groups.Conclusions: Edible oils immersed the battery, reduced the surrounding electrolysis, and thus attenuated battery discharge. As a result, treatment with edible oils attenuated the pH alkalization and tissue damage in button battery injury of pig esophageal segments. These results indicate that edible oils might be used in the treatment of button battery ingestion.

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. 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. 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. 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. • Esophageal diverticular following button battery ingestion has not been reported. • Thoracotomy following button battery ingestion is rarely indicated as endoscopic procedures are effective and less morbid. • In our case, a delay in diagnosis led to a morbid procedure. [ABSTRACT FROM AUTHOR]

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Abstract Introduction Acute button battery ingestion is an uncommon but life-threatening ingestion. This case was developed to review and teach PGY1-PGY3 emergency medicine residents and pediatric emergency medicine fellows aspects critical to the evaluation and recognition of a button battery lodged in the esophagus based on radiographic characteristics, and to know the importance of immediate removal. Methods This case contains four elements to help run the simulation: (1) a case narrative, which includes all pertinent case information, interpretations of the case information, and anticipated case branch points, (2) a PowerPoint that contains pertinent case lab information and X-ray to be used during the case simulation, (3) a PowerPoint that contains teaching points for the debriefing session, and (4) an evaluation form that contains recommended care actions. A group simulation case scenario was chosen to promote clinical decision making and to critically evaluate those management decisions. Results This case was run several times with both senior and junior emergency medicine residents, as well as pediatric fellows. Some junior residents did not recognize the object as a button battery or were unaware of the importance of immediate removal. Senior residents usually recognized the location of the battery and understood the importance of immediate removal. The case has good teaching value for medical students or mid-levels as well. Discussion The simplicity of the case lends itself best to a low-fidelity experience with individuals or a small group of residents. Expected discussion topics include a basic overview and evaluation of a foreign body ingestion, particularly a button battery, and management guidelines. The combination of participation in the simulation scenario, interactive feedback session focused on debriefing questions, and review of the brief PowerPoint lecture addressed all of the listed objectives for the learners. The case was definitively effective in teaching about button battery ingestions.

Spondylodiscitis is a rare complication of unwitnessed button battery ingestion in children. We report a case of a 20-month-old girl who presented to the emergency room 2 weeks after endoscopic removal of unwitnessed, impacted esophageal battery. Delayed presentation of spondylodiscitis after foreign body removal is related to local injury, pressure necrosis, and perforation. The bilaminar shape of an unknown ingested foreign body should alert the treating physician that it might be a battery rather than a coin. Prompt evaluation with magnetic resonance imaging is essential to prevent neurological deficit and/or spinal deformities. [ABSTRACT FROM AUTHOR]

Abstract: Button battery ingestion is a hazardous condition which is associated with the increasing technology in household products and using button battery for power supply. Most of the button battery ingestions are unwitnessed so parents’ unawareness of the potential lethal outcomes may delay the doctor visit. Lack of a clear approach or strategy for diagnosis and treatment in the first line medical caregivers is the major concern. The current study presents two cases with neglected button battery ingestion referred to the emergency ward of Pediatrics Hospital of Tabriz. With regard to review of articles and authors’ experiences a management protocol to early diagnosis is outlined for any suspected patients while the proper treatments to decline the life threatening complications are suggested which are simple to do for local practitioners. [Copyright &y& Elsevier]

An ingested foreign body lodged in the esophagus is common in children. Button batteries impacted in the esophagus need early diagnosis and intervention to avoid complication. We report a case of neglected button battery impacted in the upper esophagus in a 15-month-old female child. The problems encountered during the course of management have been discussed along with the review of the literature. Button battery ingestions in children need to be considered as an emergency and prompt endoscopic removal should be advocated. Rigid esophagoscopy is the gold standard technique of removing esophageal foreign bodies. Complication must be anticipated and managed at the earliest. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Outcomes of pediatric button battery ingestions have worsened substantially, predominantly related to the emergence of the 20-mm-diameter lithium cell as a common power source for household products. Button batteries lodged in the esophagus can cause severe tissue damage in just 2 hours, with delayed complications such as esophageal perforation, tracheoesophageal fistulas, exsanguination after fistulization into a major blood vessel, esophageal strictures, and vocal cord paralysis. Thirteen deaths have been reported. The objective of this study was to explore button battery ingestion scenarios to formulate prevention strategies. METHODS: A total of 8648 battery ingestions that were reported to the National Battery Ingestion Hotline were analyzed. RESULTS: Batteries that were ingested by children who were younger than 6 years were most often obtained directly from a product (61.8%), were loose (29.8%), or were obtained from battery packaging (8.2%). Of young children who ingested the most hazardous battery, the 20-mm lithium cell, 37.3% were intended for remote controls. Adults most often ingested batteries that were sitting out, loose, or discarded (80.8%); obtained directly from a product (4.2%); obtained from battery packaging (3.0%); or swallowed within a hearing aid (12.1%). Batteries that were intended for hearing aids were implicated in 36.3% of ingestions. Batteries were mistaken for pills in 15.5% of ingestions, mostly by older adults. CONCLUSIONS: Parents and child care providers should be taught to prevent battery ingestions. Because 61.8% of batteries that were ingested by children were obtained from products, manufacturers should redesign household products to secure the battery compartment, possibly requiring a tool to open it. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Recent cases suggest that severe and fatal button battery ingestions are increasing and current treatment may be inadequate. The objective of this study was to identify battery ingestion outcome predictors and trends, define the urgency of intervention, and refine treatment guidelines. METHODS: Data were analyzed from 3 sources: (1) National Poison Data System (56 535 cases, 1985-2009); (2) National Battery Ingestion Hotline (8648 cases, July 1990-September 2008); and (3) medical literature and National Battery Ingestion Hotline cases (13 deaths and 73 major outcomes) involving esophageal or airway button battery lodgment. RESULTS: All 3 data sets signal worsening outcomes, with a 6.7-fold increase in the percentage of button battery ingestions with major or fatal outcomes from 1985 to 2009 (National Poison Data System). Ingestions of 20to 25-mm-diameter cells increased from 1% to 18% of ingested button batteries (1990-2008), paralleling the rise in lithium cell ingestions (1.3% to 24%). Outcomes were significantly worse for large-diameter lithium cells (⩾20 mm) and children who were younger than 4 years. The 20-mm lithium cell was implicated in most severe outcomes. Severe burns with sequelae occurred in just 2 to 2.5 hours. Most fatal (92%) or major outcome (56%) ingestions were not witnessed; At least 27% of major outcome and 54% of fatal cases were misdiagnosed, usually because of nonspecific presentations. Injuries extended after removal, with unanticipated and delayed esophageal perforations, tracheoesophageal fistulas, fistulization into major yessels, and massive hemorrhage. CONCLUSIONS: Revised treatment guidelines promote expedited removal from the esophagus, increase vigilance for delayed complications, and identify patients who require urgent radiographs. [ABSTRACT FROM AUTHOR]

We report a patient who developed bilateral vocal cord palsy following button battery ingestion. A two and half year old girl presented with a history of button battery ingestion. Rigid oesophagoscopy was performed within 3 hours. Patient developed post extubation stridor with respiratory distress. Bilateral vocal cord palsy is a rare complication of button battery ingestion which can lead to an airway catastrophe. Decision on timing of extubation is crucial to avoid immediate post operative respiratory distress. Expedited removal of lodged button battery, increased vigilance for possible complications and long term follow up is of utmost importance. [ABSTRACT FROM AUTHOR]

Objective: Ingestion of button battery, if lodges in esophagus, causes mucosal destruction in esophagus and may damage surrounding tissues due to electrochemical reactions which may lead to esophagus perforation, tracheosefageal fistula and other serious problems. We designed an experimental study to test the effect of hyperbaric oxygen therapy on battery induced electrochemical tissue damage in the esophagus of a rabbit model and possible change with duration of contact time. Methods: Button batteries were inserted in esophagus of 40 rabbits which were divided into four groups. Groups 1 and 2 had 15 min of duration of contact time of battery in esophagus, while Groups 3 and 4 had 30 min. Groups 1 and 3 had hyperbaric oxygen therapy for 3 days; Groups 2 and 4 did not. At the end of 3rd day all animals were sacrified and samples were taken from the esophagus for determination of malondialdehyde levels and for histopatholocigal examination to compare: mucosal destruction, muscular layer involvement, perforation and tracheal involvement between groups. Results: Malondialdehyde levels, mucosal destruction, muscular layer involvement, perforation and tracheal involvement were significantly higher in groups which had 30 min of contact time compared to groups which had 15 min. The same assessments were significantly higher in Group 1 (15 min of contact time with hyperbaric oxygen therapy) compared to Group 2 (15 min of contact time without hyperbaric oxygen therapy). However, the difference between Group 3 (30 min of contact time with hyperbaric oxygen therapy) and Group 4 (30 min of contact time, no hyperbaric oxygen therapy) was not significant. Conclusion: Our study demonstrated that if contact time is 15 min HBO had an additive adverse effect to electrochemically burned esophagus by increasing free radicals and eventually tissue damage. However, if the contact time is 30 min its adverse effect is shielded by huge electrochemical destruction due to long contact time. [Copyright &y& Elsevier]

Aorto-oesophageal fistula is a rare complication of foreign body ingestion from which few patients survive. Aggressive surgical treatment is the only form of effective therapy for this fatal complication. We present the successful surgical treatment of an aorto-oesophageal fistula in a child without using cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Complications from esophageal button battery impactions remain a real fear for practicing pediatric gastroenterologists and surgeons. This case describes a child who developed an aorto-esophageal fistula 25 days after initial battery ingestion and survived due to prompt placement of an aortic stent via minimally invasive surgery, avoiding an open procedure. A 6-year-old female presented acutely with a mid-esophageal button battery impaction witnessed by her parents. Presenting symptoms included chest pain and emesis. Button battery location and size were confirmed on X-ray. She underwent removal with flexible esophagogastroduodenoscopy (EGD) and rigid esophagoscopy. She was admitted to the hospital and received conservative medical management, with serial cross-sectional imaging via chest MRIs to assess the evolution of her injury according to available national guidelines, and was discharged after 12 days of close inpatient monitoring. Despite these measures the patient re-presented 25 days post-ingestion with hematemesis from a new aorto-esophageal fistula, requiring emergent cardiac catheterization with successful, life-saving aortic stent placement. She remained admitted for an additional 12 days of monitoring as her diet was advanced slowly post-catheterization. Since this second hospitalization she continues to do well, with outpatient follow-up by multiple subspecialists. This case highlights the continued uncertainty regarding the risk of developing this complication, as well as gaps in the current literature and guidelines for managing these patients following ingestion and esophageal injury. It also details the unique course following development of this complication and its surgical repair. • Button battery ingestions with esophageal impaction can lead to life-threatening complications. • These complications can occur several weeks after the initial ingestion despite conservative medical management. • Multidisciplinary teamwork resulted in prompt life-saving treatment for this patient. • Minimally invasive aortic stent placement is a possible life-saving intervention in arterio-esophageal fistula development. [ABSTRACT FROM AUTHOR]

The substantial risks of button battery ingestion in children have been known to clinicians for some time. Modern button batteries are twice as large (20 mm rather than 10 mm) and twice as powerful (3 V rather than 1.5 V) as older batteries. Ingestion of modern batteries causes earlier and more severe tissue injury, as these larger batteries are more likely to impact at areas of physiological narrowing. A high index of suspicion for ingestion, use of appropriate imaging and early removal of batteries is necessary to prevent complications. [ABSTRACT FROM AUTHOR]

We present a case of a child with an ingested lithium battery causing esophageal perforation with mediastinal injury extending to the pleural cavity. During the endoscopic retrieval of the battery, the child developed the rare complication of subcutaneous emphysema, tension pneumothorax, and pneumomediastinum from excessive iatrogenic air insufflation. The patient developed mediastinitis and had a complicated postoperative course. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The purpose of this study was to evaluate findings at serial MRI after endoscopic removal of a button battery from the esophagus in a series of pediatric patients. MATERIALS AND METHODS. Serial MRI examinations after removal of a button battery from the esophagus were reviewed retrospectively for the presence of mediastinal edema; imaging characteristics of the aorta and arteries; imaging characteristics of the trachea; and imaging characteristics of the esophageal wall at the level of injury. RESULTS. A total of 48 MRI examinations were performed on 19 patients, 89% (17/19) in the first 48 hours after battery removal. Serial MRI was performed for 84% (16/19) of patients. Initial MRI showed extensive mediastinal edema in all 17 patients who underwent MRI in the first 48 hours. Edema directly abutted major arteries in all 17 patients and abutted the airway in all 10 patients with proximal esophageal injury. Arterial vascular changes were seen in 30% (3/10) of patients with proximal esophageal injury and 57% (4/7) of patients with mid or distalesophageal injury. Airway changes were seen in 80% (8/10) of patients with proximal esophageal injury. Serial MRI showed improvement of airway changes in all patients and improvement in vessel wall changes in all but one (25%, 1/4) of the patients who had mid or distal esophageal injury. Four patients (21% [4/19]) had contained esophageal leak on esophagrams. No patients in our series developed a tracheoesophageal or vascular-enteric fistula. CONCLUSION. Our case series provides important information on natural history of MRI findings in children after endoscopic removal of a button battery from the esophagus. Further studies are needed to determine the imaging findings most sensitive and specific for severe complications, such as tracheoesophageal fistula and vascular-enteric fistula.

Objective: The objective of the study is to test whether the use of edible oil might be an early treatment strategy for reducing button battery-induced esophageal injury. Methods: A button battery was inserted into esophageal segments collected from pigs. The esophageal segments were randomly allotted to one of the following six treatments: (1) untreated (nothing injected), (2) lemon juice, (3) orange juice, (4) colza oil, (5) peanut oil, and (6) olive oil. Every hour, the battery discharge and the pH value were measured in the esophageal tissue. After treatment for 6 h, the residual voltage of the battery was measured and the esophageal tissue was processed with H&E staining. Results: In esophageal segments of the untreated group, a large area of the mucous membrane was severely eroded. Partial erosion was observed in esophageal tissues treated with either lemon juice or orange juice. Furthermore, the esophageal tissues were basically intact, had little damage when treated with oils. The highest extra-esophageal discharge voltage was recorded in the untreated group, a medium amount of discharge voltage was recorded in the lemon juice and orange juice groups, and the lowest discharge voltage was recorded in all the edible oils groups. Conclusions: Edible oils immersed the battery, reduced the surrounding electrolysis, and thus attenuated battery discharge. As a result, treatment with edible oils attenuated the pH alkalization and tissue damage in button battery injury of pig esophageal segments. These results indicate that edible oils might be used in the treatment of button battery ingestion., (Copyright © 2020 Jia, Zhang, Xu, Xie, Wei, Shan, Wang, Yin and Zhao.)

Gastrointestinal injuries secondary to button battery ingestions in children have emerged as a dangerous and difficult management problem for pediatricians. Implementation of a multidisciplinary team approach, with rapid and coordinated care, is paramount to minimize the risk of negative outcomes. In addition to providing a comprehensive review of the topic, this article outlines the authors' referral center's experience with patients with severe battery ingestion, highlighting the complications, outcomes, and important lessons learned from their care. The authors also propose an algorithm for clinical care that may be useful for guiding best management of pediatric button battery ingestion., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Disc battery ingestion in children is becoming increasingly common with the proliferation of small battery-powered electronic devices. In the case of esophageal impaction, the likelihood and severity of complications are proportionate to the time between ingestion and removal. Tracheo-esophageal fistulae (TOF) are a recognized complication and can be life-threatening. We describe an interesting case of disc battery ingestion with delayed recognition of a TOF. We document the tracheal mucosal healing process of a large airway defect and describe the role of bronchoscopy in guiding the timing of surgical intervention. This case highlights the important role of early bronchoscopic assessment in management of these patients., (© 2013 Wiley Periodicals, Inc.)