Case report: esophageal foreign body mistaken for impacted button battery

Pediatric Foreign Body Ingestion: Complications and Patient and Foreign Body Factors

Background: Management of the child who has swallowed a foreign body should be guided by the risk of complication. Objective of the Review: This review discusses the patient and foreign body characteristics most likely to be associated with complications. Discussion: Most swallowed foreign bodies will pass through the GI tract without complication. Children with pre-existing GI tract abnormalities of any sort, or those who swallow higher-risk foreign bodies, are at higher risk. Higher-risk foreign bodies include long, sharp, or pointed objects, button batteries, and small magnets. Nearly any child who presents to an Emergency Department or other acute care setting after foreign body ingestion should undergo plain radiography; other forms of imaging may also be appropriate. Primary care providers may opt for an initial observation period when there is lower risk of complication. Esophageal button batteries should be emergently removed; other esophageal objects should be promptly removed or, if low risk, allowed a brief period to pass spontaneously. Most lower GI tract foreign bodies will pass spontaneously. Prevention, while not always possible, is preferable to management of foreign body ingestion. Conclusions: Management strategies for children who have swallowed foreign bodies can be optimized by considering relevant patient and foreign body factors, and how they contribute to the risk of complication.

Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis

OBJECTIVES

Given the potential for devastating complications associated with esophageal impaction of a button battery, there is a need to distinguish between a button battery and look-alike stacked coins at the time of presentation. Given there have been no studies analyzing differences in radiographic density between these two entities, the study objective was to determine if a difference exists between esophageal coin and button battery radiographic density on plain radiograph and to describe the operative and treatment course following these two distinct entities of ingestion.

METHODS

Retrospective case series following button battery or stacked coin ingestion in a tertiary care pediatric hospital from 2003 to present. Radiographic density of each button battery and stacked coin was calculated by dividing the foreign body radiographic density by the mean density of two background radiographic sections. Radiographic density of coins versus batteries was compared using t-tests.

RESULTS

There were 22 patients identified with button battery ingestion and 47 with stacked coins. Median (range) radiographic density of button batteries on anteroposterior view was 1.16 (0.37-2.19) x background compared to 1.13 (0.09-2.65) x background of stacked coins, p = 0.198. There was similarly no statistically significant difference in lateral views, p = 0.622.

CONCLUSION

Our study suggests that radiographic density measured on diagnostic x-ray does not prove a reliable adjunctive measure to distinguish an innocuous stacked coin ingestion from the far more ominous button battery and highlights the need for prompt operative evaluation for any suspected button battery ingestion.

Ingested Metallic Spool: A Rare Cause of Acquired Tracheoesophageal Fistula

Foreign body (FB) ingestion is a common problem in children. Prolonged impaction of FB in esophagus may result in tracheoesophageal fistula (TEF). A 6-year-old girl presented with progressive dysphagia and recurrent chest infections. No history of FB ingestion was given by parents. Further investigations revealed FB (spool) in cervical esophagus. Patient was successfully managed by surgery through trans-cervical approach.

Disk Battery Ingestion in a Toddler: Less Than Meets the Eye

BACKGROUND

Pediatric foreign-body ingestions are commonly managed by emergency physicians. Risk assessment and specific intervention are dependent on the nature and location of the foreign body. Radiographic evaluation is usually necessary to help define the clinical situation.

CASE REPORT

We present an interesting case of presumed ingestion of several disk batteries by a toddler with an unexpected outcome, reviewing aspects of this clinical problem and highlighting potential pitfalls in medical decision making. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pediatric foreign-body ingestions are commonly managed in the emergency department, and timely and accurate intervention is dependent on correct defining and localization of the foreign body. This case illustrates potential pitfalls in this evaluation.

Factors predictive of risk for complications in patients with oesophageal foreign bodies

BACKGROUND

Reports on predictive risk factors associated with complications of ingested oesophageal foreign bodies are rare.

AIMS

The aim of this study was to determine the predictive risk factors associated with the complications of oesophageal foreign bodies.

METHODS

Three hundred sixteen cases with foreign bodies in the oesophagus were retrospectively investigated. The predictive risk factors for complications after foreign body ingestion were analysed by multivariate logistic regression, and included age, size and type of foreign body ingested, duration of impaction, and the level of foreign body impaction.

RESULTS

The types of oesophageal foreign bodies included fish bones (37.0%), food (19.0%), and metals (18.4%). The complications associated with foreign bodies were ulcers (21.2%), lacerations (14.9%), erosions (12.0%), and perforation (1.9%). Multivariate analysis showed that the duration of impaction (p<0.001), and the type (p<0.001) and size of the foreign bodies (p<0.001) were significant independent risk factors associated with the development of complications in patients with oesophageal foreign bodies.

CONCLUSION

In patients with oesophageal foreign bodies, the risk of complications was increased with a longer duration of impaction, bone type, and larger size.

Foreign bodies in the esophagus

BACKGROUND

One third of foreign bodies retained in the gastrointestinal tract are present in the esophagus. Their management depends on the anatomic location, shape and size of the foreign body, and duration of impaction.

METHODS

Between 1971 and 2001, 32 patients with foreign bodies in the esophagus were admitted to our service in the Wolfson Medical Center. Their charts were reviewed for preoperative diagnosis, kind and location of foreign body, length of retention, management of patients, complications, and length of hospitalization.

RESULTS

One patient was admitted with perforation of the esophagus. Thirty of the foreign bodies have been extracted at rigid esophagoscopy and two at thoracotomy. There was one complication (tear of esophageal mucosa) and one death.

CONCLUSIONS

The presence of a foreign body in the esophagus is a challenging problem. Perforations may result in death. Impaction mandates immediate extraction. Our experience indicates that the use of a rigid esophagoscope is safe and reliable. Based on this experience and that of other authors, we recommend the use of the rigid endoscope as the instrument of choice for extracting foreign bodies from the esophagus. Surgeons in training should be taught rigid esophagoscopy.