Urgency of Esophageal Foreign Body Removal: Differentiation Between Coins and Button Cell Batteries

Imaging approach to ingested foreign bodies in the neck

Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.

Two Stacked Coins Mimicking an Esophageal Button Battery: A Case Presentation and Review of the Literature

As button battery (BB) ingestion has become a popular topic with growing public awareness in recent years, pediatric otolaryngologists maintain a high index of suspicion for this diagnosis. Several recent reports have revealed the possibility for benign objects to masquerade as BBs, such as two coins stacked together or a coin with different metals in concentric rings. A 4-year-old female presented to the ED after unwitnessed ingestion of a foreign body. The child was reportedly seen playing with her sister's coin collection prior to the acute onset of drooling and dysphagia. She was vitally stable and without any shortness of breath, stridor, or wheezing. Plain film X-ray revealed a round, metallic object with a double density on the frontal view and beveled step-off on the lateral view at the level of the thoracic inlet. Due to high radiographic concern for BB ingestion, the patient was taken emergently to the operating room for a rigid esophagoscopy. A metallic object was seen at the thoracic inlet and removed with Magill forceps. The object was found to be two coins stuck together, with a smaller coin in the center of a larger coin mimicking the shape of a BB. The patient was discharged the next day without complication. This case highlights stacked coins as a radiologic masquerade for BBs as well as the emphasis on prompt esophagoscopy for both identification and removal. Radiographic densities alone cannot be relied upon to distinguish BBs from more innocuous objects, and esophagoscopy remains the mainstay of management for pediatric esophageal foreign bodies.

Secondary esophageal perforation rupture of ascending aorta 16 day accidently-swallowing button battery in a young child: A case report of esophagial foreign body and mini review

Introduction and importance

Foreign body ingestions often occur in children between the ages of six months and three years. Swallowing button battery can cause serious complications such as gastrointestinal mucosa tissue necrosis and esophageal perforation. Fatal secondary lesions after foreign body removal are rarely reported.

Case presentation

We reported a case of 18 months old boy who accidently swallowed a button battery (20 mm diameter, 3.2 mm height) which lodged in the esophagus for 3 days before removed by esophagoscope. Secondary esophageal perforation and rupture of ascending aorta resulted in death 13 days after the battery was removed. The autopsy confirmed the rupture and tissue necrosis of the esophagus and ascending aorta.

Clinical discussion

The button battery incarcerated in the second stricture of the esophagus can cause serious complications and death even after removal due to battery-induced tissue erosion. Great attention should be closely paid to early endoscopic reinspection postoperatively and take comprehensive treatment to avoid similar death.

Conclusion

When the incarceration of button batter occurs in the second stricture of esophagus, the possibility of esophageal perforation and the rupture of main artery should be considered. The comprehensive treatment after operation is as important as taking out the foreign bodies.

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18 months old boy accidently swallowed a button battery which lodged in the esophagus for 3 days before removed by esophagoscope. Secondary esophageal perforation and rupture of ascending aorta resulted in death 13 days after the battery was removed.

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The button battery incarcerated in the second stricture of the esophagus can cause serious complications and death even after removal due to battery-induced tissue erosion.

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Great attention should be closely paid to early endoscopic reinspection postoperatively and take comprehensive treatment.

Association between the corrosion of ingested lithium button battery in the esophagus and its complications in pediatric patients

PURPOSE

The incidence of lithium button battery ingestion has been increasing recently, which results in severe complications. We aimed to demonstrate the association between the corrosion of lithium button batteries in the esophagus on radiographs and their complications.

METHODS

The nine pediatric patients included in this study were classified into two groups based on the presence of severe complications. The presence and degree of corrosion on plain radiographs were evaluated. The degree of corrosion was classified into the following three grades; none: 0%; moderate: 1-50%; severe: 51-100%. Fisher's exact test was used for statistical analyses.

RESULTS

Of the nine patients, five showed complications. The number of patients who had grade none, moderate, and severe degrees of corrosion was three, four, and two, respectively. The incidence of severe complications differed significantly between the incidence of lithium button batteries' contour (without vs. with severe complications [presence/absence of corrosion] = 1/3 vs. 5/0, respectively; P = 0.0476). In cases with "none" degree of corrosion, all three cases had no complication, and in cases with a "severe" degree of corrosion, all two cases had complications.

CONCLUSION

The cases with the presence of corrosion of lithium button batteries had a higher tendency to have severe complications. Therefore, physicians should anticipate the presence of severe complications in pediatric patients with corrosion more than those without corrosion.