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Oftring ZS, Mehrtens DM, Mollin J, Hamelmann E, Gaus S. Chronic stridor in a toddler after ingestion of a discharged button battery: a case report. BMC Pediatr 2024; 24:246. [PMID: 38582899 PMCID: PMC10998317 DOI: 10.1186/s12887-024-04730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/30/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Button battery (BB) ingestions (BBI) are increasingly prevalent in children and constitute a significant, potentially life-threatening health hazard, and thus a pediatric emergency. Ingested BBs are usually charged and can cause severe symptom within 2 h. Discharged BBs ingestion is very rare and protracted symptom trajectories complicate diagnosis. Timely imaging is all the more important. Discharged BBs pose specific hazards, such as impaction, and necessitate additional interventions. CASE PRESENTATION We present the case of a previously healthy 19-month-old girl who was admitted to our pediatric university clinic in Germany for assessment of a three-month history of intermittent, mainly inspiratory stridor, snoring and feeding problems (swallowing, crying at the sight of food). The child's physical examination and vital signs were normal. Common infectious causes, such as bronchitis, were ruled out by normal lab results including normal infection parameters, negative serology for common respiratory viruses, and normal blood gas analysis, the absence of fever or pathological auscultation findings. The patient's history contained no evidence of an ingestion or aspiration event, no other red flags (e.g., traveling, contact to TBC). Considering this and with bronchoscopy being the gold standard for foreign body (FB) detection, an x-ray was initially deferred. A diagnostic bronchoscopy, performed to check for airway pathologies, revealed normal mucosal and anatomic findings, but a non-pulsatile bulge in the trachea. Subsequent esophagoscopy showed an undefined FB, lodged in the upper third of the otherwise intact esophagus. The FB was identified as a BB by a chest X-ray. Retrieval of the battery proved extremely difficult due to its wedged position and prolonged ingestion and required a two-stage procedure with consultation of Ear Nose Throat colleagues. Recurring stenosis and regurgitation required one-time esophageal bougienage during follow-up examinations. Since then, the child has been asymptomatic in the biannual endoscopic controls and is thriving satisfactorily. CONCLUSION This case describes the rare and unusual case of a long-term ingested, discharged BB. It underscores the need for heightened vigilance among healthcare providers regarding the potential hazards posed by discharged BBIs in otherwise healthy children with newly, unexplained stridor and feeding problems. This case emphasizes the critical role of early diagnostic imaging and interdisciplinary interventions in ensuring timely management and preventing long-term complications associated even to discharged BBs.
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Affiliation(s)
- Zoe S Oftring
- Department of Paediatrics, University Clinic Giessen & Marburg, Marburg, Germany
- Philipps University Marburg and University Clinic Giessen & Marburg, Institute of Digital Medicine, Marburg, Germany
- Department of Paediatrics, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany
| | - Doortje M Mehrtens
- Department of Paediatrics, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany
| | - Julian Mollin
- Department of Paediatrics, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany
- Clinic Westbrandenburg GmbH, Children's Hospital, Potsdam, Germany
| | - Eckard Hamelmann
- Department of Paediatrics, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany
| | - Sebastian Gaus
- Pediatric Emergency Department, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany.
- Notaufnahme Kinderzentrum Bethel (NoKi), Evangelisches Klinikum Bethel (EvKB), Universitätsklinik für Kinder-und Jugendmedizin, Grenzweg 10, Bielefeld, 33617, Germany.
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Philteos J, Madan Y, James AL, Propst EJ, Ostrow O, McKinnon N, Everett T, Siu J, Wolter NE. Public knowledge of button battery ingestions: A social media based cross-sectional analysis. Int J Pediatr Otorhinolaryngol 2024; 179:111902. [PMID: 38479070 DOI: 10.1016/j.ijporl.2024.111902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Button battery (BB) ingestion injuries are a devastating and preventable event within the pediatric population. Efforts to reduce the prevalence of esophageal button battery ingestion injuries include primary preventative measures. It is integral to assess the public's baseline knowledge about BB injuries to tailor future primary prevention efforts. METHODS This is a crowdsourcing survey-based study. Participants were notified through our institution's Twitter and Instagram accounts. RESULTS There were 930 completed survey responses from May to June 2022. The survey found that 87% (791/910) knew that swallowing a BB could cause injury and 71% knew that it could cause death (642/905). Eight-five percent of respondents did not know what signs and symptoms to look for after BB ingestion, only 30% (99/340) of healthcare professionals felt they would know. Only 10.1% (94/930) of participants knew to give children over 12 months old honey after suspected BB ingestion. Thirty-four percent (311/930) knew that complications could still occur even after BB were removed. Seventy-seven percent (719/930) knew that a dead BB could cause injury but only 17% knew the correct way to dispose of a dead button battery (158/930). Only 8% (72/930) of participants were knew that wrapping dead BB in tape could potentially prevent injury. CONCLUSION The current study reveals gaps in the public's understanding of BB injury including: the presentation of BB injuries; the delayed harm of BB impactions; management and mitigation strategies, and BB disposal methods. This survey provided imperative insights to help guide future education and primary prevention initiatives. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Justine Philteos
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Yasmine Madan
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adrian L James
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Olivia Ostrow
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada
| | - Nicole McKinnon
- Department of Critical Care Medicine, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Tobias Everett
- Department of Anesthesiology and Pain Medicine, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Jennifer Siu
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Masiakos PT, Jatana KR, DelMonte M, Stanford A, Aldrink JH. Day to Day Advocacy by Pediatric Health Care Providers. J Pediatr Surg 2024:S0022-3468(24)00178-7. [PMID: 38580545 DOI: 10.1016/j.jpedsurg.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/07/2024]
Abstract
This manuscript highlights the impressive advocacy work that members of the American Academy of Pediatrics have achieved and serves to inspire pediatric health care providers of all specialties to pursue such efforts beyond the acute physical need of the child. This article represents one of the Symposia presented at the 2023 American Academy of Pediatrics Section on Surgery.
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Affiliation(s)
- Peter T Masiakos
- Division of Pediatric Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kris R Jatana
- Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark DelMonte
- Chief Executive Officer, Executive Vice President of the American Academy of Pediatrics, Washington, D.C, USA
| | - Ala Stanford
- Founder, Black Doctors Consortium and Center for Health Equity, Philadelphia, PA, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
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Zhang F, Duan Q, Zhou C, Wang G, Zhang J, Ni X. Animal study: Basic mechanism of vocal cord paralysis caused by button battery ingestion in children. Int J Pediatr Otorhinolaryngol 2024; 177:111872. [PMID: 38286078 DOI: 10.1016/j.ijporl.2024.111872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 01/31/2024]
Abstract
PURPOSE Vocal cord paralysis has been reported as a common complication of button battery (BB) ingestion, and there is a need to confirm the mechanism of vocal cord paralysis for the development of a standardized treatment. METHODS A new CR2032 BB and artificial saliva were placed in a fresh pig esophagus with the recurrent laryngeal nerve (RLN); the negative electrode faced the nerve in the experimental group, while the positive electrode faced the nerve in the control group. The pH values of the intra- and extraesophageal walls were measured simultaneously. Pathological examination was performed after the esophagus and nerves were damaged. RESULTS After BB ingestion, the pH near the intraesophageal negative electrode increased rapidly, reaching 11.5 at 30 min and over 14 at 6 h, while the extraesophageal pH did not change at 1 h and began to accelerate after 2 h, reaching 10 at 6 h. After 6 h of exposure, the pathological section showed that the structure of the mucosa, submucosa, and muscle layer were destroyed; chromatin in the nucleus faded, and part of the nerve bundle in the adventitia had liquefaction necrosis. CONCLUSION The basic mechanism of vocal cord paralysis caused by BB ingestion is that the OH- generated by the electrolytic reaction of the negative electrode penetrates the esophageal wall and corrodes the RLN, which may be the cause of vocal cord paralysis caused by BB ingestion without esophageal perforation.
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Affiliation(s)
- Fengzhen Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Qingchuan Duan
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Chunju Zhou
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Guixiang Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
| | - Xin Ni
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
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Ouédraogo RWL, Traore I, Millogo M. Unusual intra-tracheal migration of a corrosive esophageal foreign body. Indian J Otolaryngol Head Neck Surg 2024; 76:1092-1094. [PMID: 38440430 PMCID: PMC10909007 DOI: 10.1007/s12070-023-04133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction: intra-tracheal migration of esophageal foreign body is very uncommon and dangerous. It is most often caused by a vulnerable foreign body accidentally swallowed. We report the first observation of intra-tracheal migration of corrosive battery in our practice, with review of the literature. Observation: It was a three-years-old girl received in ENT with dyspnea occurred on a chronic dysphagia. The chest x-ray revealed an endotracheal opacity. This proved to be a button battery that migrated into the trachea through an eso-tracheal perforation. Due to this situation, an emergency medico-surgical care was stored, with a favorable evolution at the cost of a laborious management of the residual fistula. Conclusion: Classically innocuous, esophageal foreign body can be unnoticed and became extra-esophageal through esophageal migration in general and tracheal in particular, thus transforming a chronic digestive problem into an expressive respiratory emergency.
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Affiliation(s)
- Richard Wend-Lasida Ouédraogo
- Department of Oto Rhino Laryngology in the Academic Hospital Sanou Sourô, Bobo- Dioulasso, Burkina Faso
- Higher Institute of Health Sciences, Nazi Boni University, Bobo-Dioulasso, Burkina Faso
- Department of Oto Rhino Laryngology, University Hospital Sanou Sourô, Bobo-Dioulasso, Burkina Faso
| | - Ibraïma Traore
- Department of Oto Rhino Laryngology in the Academic Hospital Sanou Sourô, Bobo- Dioulasso, Burkina Faso
- Higher Institute of Health Sciences, Nazi Boni University, Bobo-Dioulasso, Burkina Faso
| | - Mathieu Millogo
- Higher Institute of Health Sciences Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso Burkina Faso
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Cohen WG, Mchugh M, Giordano T, Jacobs IN. Anatomic Considerations of esophageal button battery ingestion for outcomes and imaging. Int J Pediatr Otorhinolaryngol 2024; 176:111803. [PMID: 38043185 DOI: 10.1016/j.ijporl.2023.111803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Button batteries (BB) are a source of significant morbidity and mortality in young children. Little data is available regarding associations between esophageal impaction location and outcomes or need for surveillance imaging. METHODS All patients treated at a single institution following BB ingestion between 2018 and 2022 were included for retrospective chart review. RESULTS Twenty patients were treated at our institution BBs were located, or most significant damage observed, in the cervical esophagus (n = 10, 50 %), followed by thoracic esophagus (n = 6, 30 %), and abdominal esophagus (n = 4, 20 %). Patients with cervical esophageal impaction were younger (482 [370-866] days), than those with thoracic (1395 [871-2369] days) or abdominal esophageal impaction (2021.5 [1230.5-3419.5] days) (p = 0.003). Zargar Mucosal Injury Grade was significantly more severe in patients with cervical button battery impaction; 8/10 (80 %) had a ≥Grade IIIB injury, compared to 2/6 (33.3 %) thoracic impactions and 0/4 (0 %) abdominal impactions (p = 0.002). All patients who developed persistent esophageal stenosis (n = 6) had cervical battery impactions (6, 60 %, p = 0.015). Both TEFs (2/2) had anterior facing anode, while both (2/2) esophageal perforations had posterior. Only 1/20 (5 %) patients, and 1/7 (14.3 %) with serious complications, had a serious complication detected on routine, rather than clinically indicated follow-up surveillance. CONCLUSIONS In our population, cervical BB impaction occurred more frequently in younger children, was associated with more severe mucosal injury, and had higher risk of stenosis. Nearly all complications were detected on clinically indicated rather than postoperative surveillance imaging.
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Affiliation(s)
- William G Cohen
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Moira Mchugh
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Terri Giordano
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ian N Jacobs
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Chen L, Gan H, Huang H, Zhang J, Tang F, Lan Q, Chen Q, Li M, Xu F, Zhong H. Prolonged Button Battery Exposure Leading to Severe Ocular Injury without Heavy Metal Poisoning. Case Rep Ophthalmol 2024; 15:170-175. [PMID: 38433780 PMCID: PMC10907000 DOI: 10.1159/000536469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/08/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Prolonged exposure to a complete button battery can cause severe tissue necrosis in the eye and permanent impairment of visual function. The main mechanism of injury is the current generated by the hydrolysis of tissue fluid at the negative electrode and the production of hydroxide ions. Case Presentation A 3-year-old girl went to the local hospital because of swelling and pain in her right eye of 12-h duration. The local doctor performed an orbital CT (computed tomography) scan and found a foreign body between the right eyelid and the eyeball. The foreign body was removed immediately under general anesthesia. In addition, it was found that the foreign body was a button battery, but it prolonged 39 h from the onset of the child's symptoms. The child underwent a second operation in our hospital and received amniotic membrane transplantation combined with conjunctival flap coverage. Topical corticosteroid and antibiotic eye ointment were continued for 3 months after surgery. Local pigmentation was seen, there was no symblepharon, but the cornea was still opaque and the visual acuity was only FC (finger count). In this particular case, heavy metal testing conducted on the child's blood fortunately revealed that the levels were within the normal range. Conclusion Early detection and urgent removal of button battery are crucial in order to minimize exposure time. We should also be concerned about heavy metals in the blood. Children should be kept away from button batteries as much as possible to avoid such injury.
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Affiliation(s)
- Lifei Chen
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences and Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Key Laboratory of Eye Health and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Haiyan Gan
- Department of Ophthalmology, The People’s Hospital of Guangxi Cenxi City, Cenxi, China
| | - Hui Huang
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences and Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Key Laboratory of Eye Health and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Jiuming Zhang
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences and Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Key Laboratory of Eye Health and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Fen Tang
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences and Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Key Laboratory of Eye Health and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Qianqian Lan
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences and Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Key Laboratory of Eye Health and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Qi Chen
- Department of Optometry, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Min Li
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences and Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Key Laboratory of Eye Health and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Fan Xu
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences and Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Key Laboratory of Eye Health and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
| | - Haibin Zhong
- Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences and Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Key Laboratory of Eye Health and Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, China
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Reddy SM, Lander AD, Stumper O, Botha P, Khan N, Pachl M. Esophago-Vascular Fistulae in Children: Five Survivors, Literature Review, and Proposal for Management. J Pediatr Surg 2023; 58:1969-1975. [PMID: 37208288 DOI: 10.1016/j.jpedsurg.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Esophago-vascular fistulae in children are almost uniformly fatal with death occurring by exsanguination. We present a single centre series of five surviving patients, a proposal for management and literature review. MATERIALS AND METHODS Patients were identified from surgical logbooks, surgeon recollection and discharge coding data. Demographics, symptoms, co-morbidities, radiology, management and follow up details were recorded. RESULTS Five patients (1M, 4F) were identified. Four were aorto-esophageal and one caroto-esophageal. Median age at initial presentation was 44 (8-177) months. Four patients had cross sectional imaging prior to surgery. Median time from presentation to combined entero-vascular surgery was 15 (0-419) days. Four patients required repair on cardio-pulmonary bypass with four undergoing staged surgical procedures. All required combined esophageal and cardio-vascular surgery. Length of PICU stay following combined surgery was 4 (2-60) days and overall hospital stay was 53 (15-84) days. Median follow up was 51 (17-61) months. Two patients had esophageal atresia and trachea-esophageal fistula managed as neonates. Three had no co-morbidities. Four had esophageal foreign bodies:1 esophageal stent, 2 button batteries, 1 chicken bone. One patient had a complication following colonic interposition. Four patients required an esophagostomy at the time of definitive surgery. All patients were alive and well at last follow up with one having successful reconnection surgery. CONCLUSION In this series, outcomes were favourable. Multidisciplinary discussion and surgery are mandatory. If hemorrhage is controlled at presentation, then survival to discharge is possible but the magnitude of surgical intervention is both significant and very high risk. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Snighda M Reddy
- Department of Paediatric Surgery, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Anthony D Lander
- Department of Paediatric Surgery, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Oliver Stumper
- Department of Cardiology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Phil Botha
- Department of Cardiac Surgery, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Natasha Khan
- Department of Cardiac Surgery, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Max Pachl
- Department of Paediatric Surgery, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.
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Afshari FT, Gee O, Lo WB. Spondylodiscitis following ingestion of button battery in an infant-a case-based update. Childs Nerv Syst 2023:10.1007/s00381-023-05949-6. [PMID: 37055484 DOI: 10.1007/s00381-023-05949-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
Button battery ingestion in infants is an increasingly common surgical emergency which can lead to oesophageal perforation, mediastinitis, trachea-oesophageal fistulation, airway compromise and death. One exceedingly rare complication of battery ingestion is discitis and osteomyelitis in the cervical and upper thoracic spine. Diagnosis is normally delayed due to the non-specific presentation, delayed imaging findings and the initial clinical focus on dealing with the immediate, and potentially life-threatening, complications. We describe a case of a 1-year-old girl who presented with haematemesis and an oesophageal injury, secondary to button battery ingestion. Sagittal reconstruction of the CT chest demonstrated a suspicious area of vertebral erosion in the cervicothoracic spine which prompted a further evaluation with MRI demonstrating spondylodiscitis of C7-T2 with vertebral erosion and collapse. The child was successfully treated with long course of antibiotics. We wish to highlight the importance of clinical and radiological spinal assessment in children with button battery ingestion to avoid delayed diagnosis and complications of spinal osteomyelitis.
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Affiliation(s)
- Fardad T Afshari
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Oliver Gee
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - William B Lo
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
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Akgül G, Sancaktar ME, Özdemir D, Mehel MD, Turgut NF, Çeçen A. Mechanism of ear canal button battery injury and strategies for mitigation of damage. Acta Otorhinolaryngol Ital 2023; 43:149-154. [PMID: 37099439 PMCID: PMC10132484 DOI: 10.14639/0392-100x-n2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/02/2022] [Indexed: 04/27/2023]
Abstract
Objectives In this study, the damage caused by button batteries (BB) trapped in the ear canal (EC) and strategies to reduce this damage before their removal were investigated in vitro. Methods After four EC models prepared from freshly frozen cadaveric bovine ears were thawed, 3 V lithium BBs were placed in the channels. After a three-hour period of preliminary damage, nothing was applied to the first EC model, the second EC model underwent saline administration, the third EC model underwent boric acid administration, and the fourth EC model underwent the administration of 3% acetic acid. The voltage, tissue temperature, and pH of the BBs were measured. The BBs were removed at the end of the 24th hour, and the EC models were examined by a pathologist. Results The greatest decrease in pH was detected in the fourth EC model in which acetic acid was administered. The depth of necrosis was 854 µm in the first EC model, 1858 µm in the second EC model, and 639 µm in the third EC model at the end of the 24th hour. No necrosis was detected in the fourth EC model. Conclusions Lithium BBs can cause alkaline tissue damage in a short time in cadaveric EC models. pH neutralisation strategies appear to be experimentally successful under in vitro conditions.
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Affiliation(s)
- Gökhan Akgül
- University of Health Sciences Turkey, Samsun Health Practices and Research Center, Department of Otorhinolaryngology, Samsun, Turkey
| | - Mehmet Eser Sancaktar
- Ankara Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey
| | - Doğukan Özdemir
- Samsun University, Faculty of Medicine, Department of Otorhinolaryngology, Samsun, Turkey
| | - Mehmet Dursun Mehel
- University of Health Sciences Turkey, Samsun Health Practices and Research Center, Department of Otorhinolaryngology, Samsun, Turkey
| | - Nesrettin Fatih Turgut
- University of Health Sciences Turkey, Samsun Health Practices and Research Center, Department of Otorhinolaryngology, Samsun, Turkey
| | - Ayşe Çeçen
- Samsun University, Faculty of Medicine, Department of Otorhinolaryngology, Samsun, Turkey
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11
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Keloth T, AbdullGaffar B, Ahmad M. Histopathologic Findings of Button Battery-Related Changes in a Perforated Meckel's Diverticulum: Report of Three Cases. Fetal Pediatr Pathol 2023; 42:253-258. [PMID: 35543308 DOI: 10.1080/15513815.2022.2074588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: A button battery can cause perforation of Meckel's diverticulum if sequestered in this blind ending bowel segment. Reported cases focused on clinical manifestations, management options, radiologic and intraoperative findings. We highlight the histopathologic features in perforated Meckel's diverticula due to ingested button batteries. Case report: Three toddlers presented with perforated Meckel's diverticula after button battery ingestion. Histologic examination of the diverticula showed multiple burn-like mucosal ulcerations and liquefactive wall perforations of the tips, associated with prominent siderotic pigment deposits and calcifications. There were various residual materials with variable staining patterns in the luminal debris, necrotic tissue and adjacent to submucosal blood vessels. Conclusion: There is accelerated deposition of iron and calcium associated with button batteries.
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Affiliation(s)
- Tasnim Keloth
- Pathology, Dubai Hospital, Dubai, United Arab Emirates
| | | | - Munir Ahmad
- Pediatric Surgery, Latifa Hospital, Dubai, United Arab Emirates
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12
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Al-Taie B, Rosvall O, Larsson M, Edholm D. Button battery injury causing an aorto-oesophageal fistula in a 1-year-old child - Sengstaken-Blakemore tube, a life-saving bridge during surgery. Paediatr Int Child Health 2023; 43:19-22. [PMID: 38018156 DOI: 10.1080/20469047.2023.2277506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
ABBREVIATION AEF: aorto-oesophageal fistula;BB: button battery;CTA: computed tomography angiography;ER: emergency room;GI: gastro-intestinal;SBT: Sengstaken-Blakemore tube.
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Affiliation(s)
- Baraa Al-Taie
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Oda Rosvall
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Magnus Larsson
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - David Edholm
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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13
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Brandt K, Dukleska K, McKeown M, Brancato J, Grossi V, Schoem S, Sacco T, D'Amato J, Bourque MD, Campbell BT. Utilizing a critical airway response team expedites esophageal button battery removal. J Pediatr Surg 2023; 58:810-813. [PMID: 36805142 DOI: 10.1016/j.jpedsurg.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Esophageal button battery ingestion is a significant problem that can lead to significant complications such as tracheoesophageal fistula, esophageal perforation, and aortoesophageal fistula. Due to this, prompt recognition and treatment is integral in the care of these patients. METHODS Patients who presented to a single institution from August 2015 to April 2022 with esophageal button battery ingestion were included in this study. All esophageal button battery ingestion patients were included in a clinical algorithm for Critical Airway Response Team (CART) activation in October 2019. Time from diagnosis to treatment was compared for pre-CART clinical algorithm implementation to post-CART. RESULTS Data on pre-CART patients (n = 6) and post-CART patients (n = 7) was collected. Including esophageal button battery ingestions to CART activations shortened the time from chest x-ray to button battery removal from 73 ± 32 min to 35 ± 11 min (p < 0.05). CONCLUSION These data highlight the importance of implementation of a clinical care algorithm to shorten the time from diagnosis to treatment in patients with esophageal button battery ingestion. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kylie Brandt
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Katerina Dukleska
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Morgan McKeown
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA
| | - John Brancato
- Department of Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Victoria Grossi
- Department of Gastroenterology, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Scott Schoem
- Department of Otolaryngology, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Tina Sacco
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Jennifer D'Amato
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Michael D Bourque
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Brendan T Campbell
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
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14
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Lavin JM, Corboy J, Katsogridakis Y, Pham OK, Brinson D, Krug S. Electronic medical record based tools: Not a panacea in the diagnosis of coin-shaped foreign bodies. Int J Pediatr Otorhinolaryngol 2023; 164:111410. [PMID: 36529040 DOI: 10.1016/j.ijporl.2022.111410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Electronic medical record-based tools have been demonstrated to improve timeliness of x-ray order placement in patients presenting to the emergency department (ED) with coin-shaped foreign body ingestion. Similar efforts directed towards downstream processes are necessary to expedite diagnosis of an esophageal button battery. We predicted that improvement tools such as electronic medical record-based alerts and process standardization could be utilized to expedite x-ray completion. METHODS Using Plan, Do, Study, Act methodology, iterative interventions were implemented. In July 2017 a previously designed best practice advisory was linked to an automated notification page to the x-ray technician. Next, a standardized process was created where patients were gowned in triage and placed in a designated space awaiting x-ray. Workflow planning began in December 2018 and was formalized in February 2019. Time from arrival to x-ray completion was tracked for patients presenting with coin-shaped foreign body ingestion. Control charts were used to determine special cause variation. RESULTS An average of 10.1 patients (Range 4-21) presented monthly to the ED with coin-shaped foreign body ingestion. Automated pages to the x-ray technician were not associated with improved time to x-ray completion. Upon initiation of the new patient workflow, median time to x-ray completion decreased from 37.4 to 23.3 min. CONCLUSION Time to x-ray completion in children presenting to the ED with ingestion of coin-shaped foreign bodies is not improved solely through electronic notification of the imaging technologist. Efforts to standardize processes for patient intake and placement are associated with more timely completion of imaging studies. Generalizability of findings may depend on contextual elements of individual healthcare units.
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Affiliation(s)
- Jennifer M Lavin
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jacqueline Corboy
- Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yiannis Katsogridakis
- Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Oanh K Pham
- Center for Quality and Safety, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Dusty Brinson
- Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Steve Krug
- Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Gyawali BR, Guragain R, Gyawali DR. Role of Honey and Acetic Acid in Mitigating the Effects of Button Battery in Esophageal Mucosa: A Cadaveric Animal Model Experimental Study. Indian J Otolaryngol Head Neck Surg 2022; 74:5759-5765. [PMID: 36742683 PMCID: PMC9895233 DOI: 10.1007/s12070-021-02382-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
The objective of our study was to evaluate the role of honey and acetic acid in mitigating the mucosal injury posed by button battery using esophagus specimens from goat cadavers. This was an in vitro experimental cadaveric animal model laboratory study. We used 40 specimens of cadaveric goat esophagus and divided into four groups (A, B, C and D). The first comparison was between group A (specimens with button battery only) and group B (specimens with button battery coated with honey) for the difference in the degree of mucosal injury and change in pH and temperature. The second comparison was between group C (specimens with button battery removed after six hours) and group D (specimens with 5% acetic acid applied following the removal of the battery after six hours) for the difference in the progression of the mucosal injury and change in pH and temperature. The observer was blinded regarding the allocation of the groups. We used Fisher's exact test and independent sample t-test, to evaluate the statistical association. There was a statistically significant reduction in the degree of mucosal injury in specimens applied with button battery coated with honey compared to the specimens applied with button battery only. Similarly, progression of the mucosal injury was halted in specimens with the application of acetic acid following the removal of the button battery. Honey and acetic acid can mitigate the mucosal effects posed by the button battery in cadaveric goat esophageal specimens.
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Affiliation(s)
- Bigyan Raj Gyawali
- Department of ENT-HNS, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj road, Kathmandu, 44600 Nepal
| | - Rajendra Guragain
- Department of ENT-HNS, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj road, Kathmandu, 44600 Nepal
| | - Dhruba Raj Gyawali
- Department of Science & Research, West Point School, Chandragiri-3, Kathmandu, Nepal
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16
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Lotfallah A, Al-Hity S, Rodrigues R, Hamzah A, Kumar R, Darr A. Button batteries in the ear, nose and throat: a novel survey of knowledge of UK advanced nurse practitioners. Br J Nurs 2022; 31:624-630. [PMID: 35736845 DOI: 10.12968/bjon.2022.31.12.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Button battery (BB) impaction in the ear, nose and throat can result in significant morbidity. Advanced nurse practitioners (ANPs) are increasingly responsible for initial patient assessment and prompt escalation to otolaryngologists for definitive management. AIM Our novel national study aimed to assess ANPs' knowledge with respect to the assessment and management of patients with BBs in the ear, nose and throat. METHOD A national 13-point survey was disseminated among ANPs over a 2-week period. Knowledge was assessed through eight multiple choice questions with a maximum attainable score of 21. FINDINGS A total of 242 responses were analysed. Knowledge deficits were identified in all domains (mean overall score 8.5/21), including presenting clinical features, preliminary investigations and intervention strategies. The overwhelming majority of respondents (97%; n=234) advocated for further training. CONCLUSION A need for further education has been highlighted by this surveyed cohort of ANPs. Implementation of standardised protocols, virtual resources and simulation platforms may address knowledge deficits.
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Affiliation(s)
- Andrew Lotfallah
- Ear, Nose and Throat (ENT), Senior House Officer, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton
| | - Shams Al-Hity
- ENT Senior House Officer, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton
| | - Rodney Rodrigues
- Specialist ENT Registrar, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton
| | - Aisha Hamzah
- ENT Clinical Nurse Specialist, Birmingham Women's and Children's NHS Foundation Trust, Birmingham
| | - Ravi Kumar
- ENT Registrar, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton
| | - Adnan Darr
- Rhinology and Anterior Skull Base Fellow, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton
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17
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Poupore NS, Shih MC, Nguyen SA, Brennan EA, Clemmens CS, Pecha PP, McDuffie LA, Carroll WW. Evaluating the management timeline of tracheoesophageal fistulas secondary to button batteries: A systematic review. Int J Pediatr Otorhinolaryngol 2022; 157:111100. [PMID: 35523610 DOI: 10.1016/j.ijporl.2022.111100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION During the SARS-CoV-2 pandemic, the incidence of pediatric button battery (BB) ingestions has risen. Children have spent more time at home from school, while many parents try to balance working from home and childcare. Additionally, the amount of electronics powered by BB has increased. Tracheoesophageal fistula (TEF) secondary to a retained aerodigestive BB is a devastating development. Management is challenging, and the clinical timeline of watchful waiting versus surgical intervention for TEF is poorly defined in the literature. METHODS In accordance with PRISMA guidelines, databases searched include PubMed, Scopus, and CINAHL from database date of inception through August 13, 2021. All study designs were included, and no language, publication date, or other restrictions were applied. Case series and reports of TEFs secondary to BBs were included. Clinical risk factors and outcomes were compared between the spontaneous closure and surgical repair groups. RESULTS A total of 79 studies with 105 total patients were included. Mortality was 11.4%. There were 23 (21.9%) TEFs that spontaneously closed and 71 (67.6%) that underwent surgical repair. Median time to spontaneous closure compared to surgical repair was significantly different (8.0 weeks [IQR 4.0-18.4] vs. 2.0 weeks [IQR 0.1-3.3], p<0.001). Smaller TEFs were more likely to spontaneously close versus being surgically repaired (9.3 mm ± 3.5 vs. 14.9 mm ± 8.3, p=0.022). Duration of symptoms before BB discovery, BB size, time between BB removal and TEF discovery, and location of the TEF were not statistically different between the spontaneous closure and surgical repair groups. CONCLUSION A TEF secondary to BB ingestion is a potentially deadly complication. Timing of reported TEF spontaneous closure varies significantly. While smaller TEFs may be amenable to healing without surgical repair, no other significant factors were identified that may be associated with spontaneous closure. If clinical status permits, these data suggest a period of observation of at least 8 weeks prior to surgical intervention may be practical for many BB-induced TEFs.
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Affiliation(s)
- Nicolas S Poupore
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA.
| | - Michael C Shih
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Shaun A Nguyen
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Emily A Brennan
- Medical University of South Carolina, Department of Research and Education Services, Medical University of South Carolina Libraries, 171 Ashley Avenue, Charleston, SC, 29425, USA
| | - Clarice S Clemmens
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Phayvanh P Pecha
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Lucas A McDuffie
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - William W Carroll
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
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18
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Rostad BS, Richer EJ, Riedesel EL, Alazraki AL. Esophageal discoid foreign body detection and classification using artificial intelligence. Pediatr Radiol 2022; 52:477-482. [PMID: 34850259 DOI: 10.1007/s00247-021-05240-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Early and accurate radiographic diagnosis is required for the management of children with radio-opaque esophageal foreign bodies. Button batteries are some of the most dangerous esophageal foreign bodies and coins are among the most common. We hypothesized that artificial intelligence could be used to triage radiographs with esophageal button batteries and coins. OBJECTIVE Our primary objective was to train an object detector to detect esophageal foreign bodies, whether button battery or coin. Our secondary objective was to train an image classifier to classify the detected foreign body as either a button battery or a coin. MATERIALS AND METHODS We trained an object detector to detect button batteries and coins. The training data set for the object detector was 57 radiographs, consisting of 3 groups of 19 images each with either an esophageal button battery, esophageal coin or no foreign body. The foreign bodies were endoscopically confirmed, and the groups were age and gender matched. We then trained an image classifier to classify the detected foreign body as either a button battery or a coin. The training data set for the image classifier consisted of 19 radiographs of button batteries and 19 of coins, cropped from the object detector training data set. The object detector and image classifier were then tested on 103 radiographs with an esophageal foreign body, and 103 radiographs without a foreign body. RESULTS The object detector was 100% sensitive and specific for detecting an esophageal foreign body. The image classifier accurately classified all 6/6 (100%) button batteries in the testing data set and 93/95 (97.9%) of the coins. The remaining two coins were incorrectly classified as button batteries. In addition to these images with a single button battery or coin, there were two unique cases in the testing data set: a stacked button battery and coin, and two stacked coins, both of which were classified as coins. CONCLUSION Artificial intelligence models show promise in detecting and classifying esophageal discoid foreign bodies and could potentially be used to triage radiographs for radiologist interpretation.
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Affiliation(s)
- Bradley S Rostad
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA. .,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Edward J Richer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Erica L Riedesel
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Adina L Alazraki
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
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19
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Chao S, Gibbs H, Rhoades K, Mehrer C, Jacobs IN, Jatana KR. Button battery taping and disposal: Risk reduction strategies for the household setting. Int J Pediatr Otorhinolaryngol 2022; 153:111008. [PMID: 34986444 DOI: 10.1016/j.ijporl.2021.111008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/02/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Pediatric esophageal button battery (BB) injury occurs rapidly and continues to be a significant source of morbidity and mortality. Unfortunately, a BB that no longer supplies power to a device can still have enough residual voltage to cause injury within the body. Development of additional prevention strategies for consumers may reduce esophageal injury risk. METHODS In this study, 24 commercially available button batteries (BBs) were horizontally and vertically wrapped (2 layers, full circumferential coverage, 90° apart) with 6 different types of common household tapes (Scotch®/clear, Scotch®/Magic, masking tape, packing tape/clear, packing tape/brown, black electrical tape) and left at room temperature for 30 days. In addition, 6 of the CR2032 batteries covered with each type of tape were placed in a cadaveric piglet esophageal model for a 4-h period and then compared to controls without tape for tissue pH changes and visible tissue injury. RESULTS None of the tape-wrapped batteries showed voltage changes nor presented any hazard stemming from BB ingestion. All 6 tape covered batteries placed in the cadaveric piglet esophageal tissue model demonstrated no visible tissue injury and no change in tissue pH in contrast to the controls. Review of BB packaging language from various brands of commercially available CR2032 batteries showed that none had specific disposal recommendations. CONCLUSION Both BB and electronics manufacturers should consider instructing the use of common household tape options to cover these BB immediately after removal from a device for either recycling or disposal. Such precautions may help to reduce related ingestion injuries in children.
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Affiliation(s)
- Silas Chao
- Northeast Ohio Medical University, 4209 OH-44, Rootstown, OH, 44272, USA; Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Medical Center, Honolulu, HI, 96859, USA
| | - Hannah Gibbs
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Keith Rhoades
- Intertek Product Assurance, 545 E. Algonquin Rd Suite F, Arlington Heights, IL, 60005, USA; Global Injury Research Collaborative, 1391 W. 5th Avenue #258, Columbus, OH, 43212, USA
| | - Christopher Mehrer
- Intertek Product Assurance, 545 E. Algonquin Rd Suite F, Arlington Heights, IL, 60005, USA
| | - Ian N Jacobs
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Kris R Jatana
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at Ohio State University, 410 W 10th Ave, Columbus, OH, 43210, USA; Global Injury Research Collaborative, 1391 W. 5th Avenue #258, Columbus, OH, 43212, USA.
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20
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Yogev D, Lev-Tzion R, Ledder O, Orlanski-Meyer E, Zharkov E, Cytter-Kuint R. Retained metal fragments following esophageal button battery impaction. Eur J Pediatr 2022; 181:143-147. [PMID: 34223968 DOI: 10.1007/s00431-021-04184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
Button battery (BB) impaction in the esophagus requires immediate endoscopic removal and meticulous follow-up, including serial cross-sectional imaging, preferably with magnetic resonance imaging (MRI). However, BBs quickly degrade in the esophagus, and metallic fragments may remain in the injured mucosa following removal. This metallic debris can cause thermal injury during MRI, potentially aggravating local injury. We aimed to explore whether such metallic fragments could be identified on imaging following BB removal. In this study, we conducted a retrospective review of children (0-18 years) presenting with BB impaction in the esophagus between 2014 and 2020. Endoscopy reports and imaging studies were blindly reviewed by a pediatric gastroenterologist and a pediatric radiologist. Of 161 cases of battery ingestion, 14 (8%) underwent endoscopy, and in 9 (5%) a BB was impacted in the esophagus. The median time from ingestion to BB removal was 8 h (range 2-48 h). The median time from removal to CT was 44 h (range 0.5-104 h). BB appearance ranged from mild corrosion to visible debris. Pre-removal plain films showed irregular battery contour suggesting corrosion (5/7 plain films). In 7/9 CT scans (78%), high-attenuation esophageal content (median 266HU (range 140-1151)), which may represent metallic debris, was identified. Five patients had a follow-up CT which still showed gradual resolution of the high-attenuation content.Conclusions: we describe a new finding on CT following BB removal which might represent metallic debris. Clinicians should be aware of these findings which potentially may be harmful during MRI used in the ongoing assessment of esophageal injury. What is Known: • Button batteries are a dangerous pediatric foreign body with potentially fatal vascular complications. What is New: • Metallic debris was identified on computerized tomography following button battery removal in most children. • We bring to attention this new finding which may affect clinical management, as minimal metallic content can cause burns during MRI.
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Affiliation(s)
- Dotan Yogev
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raffi Lev-Tzion
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Oren Ledder
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Orlanski-Meyer
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elena Zharkov
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ruth Cytter-Kuint
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. .,Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel.
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21
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Zain M, Khairi A, Abouheba M. Delayed Presentation of Congenital Jejunal Web beyond the Neonatal Period. Case Rep Gastroenterol 2021; 15:545-550. [PMID: 34616254 PMCID: PMC8454231 DOI: 10.1159/000516685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022] Open
Abstract
Congenital web of the gastrointestinal tract is a rare anomaly which may present at any site of the gastrointestinal tract. In cases with an intact membrane, the presenting symptoms may take the form of complete intestinal obstruction while in other cases with a fenestrated membrane, it may present with partial intestinal obstruction such as failure to thrive, volume depletion, or poor body-weight gain, representing a chronic condition. It is very rare for a jejunal web to present with retention of accidently ingested foreign body. In this report, we document a case of 14-month boy with retention of accidently ingested button battery who was found to have a jejunal web on surgical exploration. This case report stresses on the importance of prevention of ingestion of inanimate foreign bodies especially in young infants and that the absence of symptoms does not preclude presence of foreign body in children. Also, surgeons should be prepared to deal with other unsuspected findings intraoperatively. After a review of the literature, jejunal web should be considered in the differential diagnosis of chronic partial intestinal obstruction even in adults.
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Affiliation(s)
- Mostafa Zain
- Department of Pediatric Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Khairi
- Department of Pediatric Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Abouheba
- Department of Pediatric Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Shafiq S, Devarbhavi H, Balaji G, Patil M. Button battery ingestion in children: Experience from a tertiary center on 56 patients. Indian J Gastroenterol 2021; 40:463-469. [PMID: 34613568 DOI: 10.1007/s12664-021-01192-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/03/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM The ubiquitous use of portable electronic devices has resulted in an increased incidence of button battery (BB) ingestion in children. BB ingestion represents a distinct category of ingested foreign body due to the associated high morbidity and mortality. The aim of this study was to report our experience in the management of BB ingestion in children. METHODS We reviewed the clinical and endoscopic characteristics of 56 children (≤ 18 years) who presented to our hospital emergency department (ED) with BB ingestion between December 2016 and November 2019. Data with respect to patient demographics, time of presentation to ED to endoscopic retrieval of BB, the endoscopic findings, and complications, if any, were collected. RESULTS We encountered a total of 56 children with BB ingestions. While 10 BBs passed off spontaneously without any complication, 27 BBs were extracted endoscopically from the stomach. A total of 19 BB impactions occurred: 9 at the cricopharynx/upper esophageal sphincter (UES), 5 in the mid esophagus, 4 in the lower esophagus, and one at the pyloric ring. All impactions occurred with larger BBs (diameter ≥ 10 mm). Complications occurred in 3 children (5.35%) following retrieval; 2 developed upper esophageal strictures on follow-up, which were treated with serial dilations and one experienced esophageal perforation and peritonitis requiring laparotomy. There was no mortality in our study. CONCLUSIONS A vast majority of ingested BBs pass off spontaneously or require minimal endoscopic intervention. Serious complications arise in a small minority especially in BBs > 10 mm in size with a potential for esophageal impaction.
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Affiliation(s)
- Syed Shafiq
- Department of Medical Gastroenterology, St. John's Medical College Hospital, Sarjapur Road, Bengaluru, 560 034, India.
| | - Harshad Devarbhavi
- Department of Medical Gastroenterology, St. John's Medical College Hospital, Sarjapur Road, Bengaluru, 560 034, India
| | - Gurappa Balaji
- Department of Gastroenterology, Fortis Hospital, 154, 9, Bannerghatta Main Road, Sahyadri Layout, Bilekahalli, Bengaluru, 560 076, India
| | - Mallikarjuna Patil
- Department of Medical Gastroenterology, St. John's Medical College Hospital, Sarjapur Road, Bengaluru, 560 034, India
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Grey NEO, Malone LJ, Miller AL, Carroll HF, Khalaf RT, Kramer RE, Browne LP. Magnetic resonance imaging findings following button battery ingestion. Pediatr Radiol 2021; 51:1856-66. [PMID: 34075452 DOI: 10.1007/s00247-021-05085-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/05/2021] [Accepted: 04/20/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Lithium button battery ingestions have been increasing in frequency since the early 2000s and can develop severe and sometimes fatal complications from caustic injury even after rapid battery removal. To aid in clinical decision-making, we began obtaining magnetic resonance imaging (MRI)/MR angiography in these patients. OBJECTIVE Our goal was to review MRI/MR angiography imaging in button battery ingestion cases and compare with other imaging, clinical data and outcomes in these patients. MATERIALS AND METHODS In this retrospective institutional-review-board-approved study, we reviewed all button battery ingestion cases with MRI from April 2012 to September 2018. Clinical data, endoscopic findings and all imaging studies were rereviewed. MRIs were evaluated for inflammation, blooming artifact and complications including vascular injury, tracheoesophageal fistula, esophageal perforation and spondylodiscitis, and compared to endoscopy, esophagram and bronchoscopy. RESULTS Twenty-three patients with button battery ingestions had a total of 51 MRI/MR angiograms. Seventy percent of the cohort was male with a median age of 2 years (range: 0.94-17 years). Severe complications were found in 48% of patients (11/23), including esophageal perforation (n=11), tracheoesophageal fistula (n=3) and spondylodiscitis (n=1). No patients had vascular injury. Cervical location of the battery was significantly associated with severe complications (10/11 cases). The length of the blooming artifact was greater than 2 cm in those with severe complications and, in most cases, <2 cm in those without severe complications. All complications were seen on initial screening MR exam with serial exams showing decreased inflammation. CONCLUSION MRI/MR angiography can provide valuable information about complications, including esophageal perforation, tracheoesophageal fistula and spondylodiscitis. Decreasing inflammation surrounding the esophagus and vasculature is believed to be clinically reassuring and aids in managing button battery ingestion patients.
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Abstract
Foreign bodies ingestion or aspiration events in children can be a source of morbidity and mortality. In most cases, removal by a coordinated endoscopy can be performed when there is the availability of equipment and support staff for pediatric care. Close communication with the anesthesia, surgeon and operating room support staff is essential and rehearsing with a facsimile of the foreign body is useful. In certain cases, such as sharp foreign bodies or button batteries the endoscopy should be performed immediately.
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Voelker J, Voelker C, Voelker J, Engert J, Schendzielorz P, Hagen R, Rak K. Button batteries and typical swallowed foreign bodies can be differentiated in high-resolution X-Rays. Int J Pediatr Otorhinolaryngol 2021; 142:110604. [PMID: 33421671 DOI: 10.1016/j.ijporl.2020.110604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Button battery ingestions have emerged as an increasing medical issue in recent years, especially for children. The frequent use of these energy sources in small appliances and toys is responsible for their ubiquitous occurrence in households. In addition to other possible foreign bodies, button batteries are particularly dangerous as they can cause severe complications in the aerodigestive tract. OBJECTIVE The study aimed for a detailed analysis of specific radiographic identifiers of button batteries and similarly configured potential esophageal foreign bodies in high-resolution X-ray scans. METHODS A selection of potentially hazardous button batteries - in cases of ingestion (CR2032) or aspiration (LR44, LR1130) - was made. Other clinically relevant radio-opaque objects of similar size and shape have been selected accordingly. High-resolution X-ray scans (33.3 lp/mm) were made using an in vitro model in porcine esophageal preparations. A systematic, comparative analysis was carried out with the digital radiographic images. FINDINGS In the study described, the selected foreign bodies were scanned at distinct angles in high image quality. Using button batteries, radiographically details of their internal structures were shown that have not yet been described. The known markers, as well as new detailed characteristics, were found in the experimental setting. The differentiation from other typical esophageal foreign bodies was possible by analyzing four relevant identification features: the edge properties, internal structures, the size, and differences in 0°/90° scans. CONCLUSIONS The study results reveal that specific features of potential esophageal foreign bodies can be identified by improved radiographic resolution, contrast, and dynamics. Thus, the diagnostic reliability in distinguishing 'high-risk foreign bodies' from less dangerous ones could be increased. In the future, button batteries could be detected more reliably with intelligent digital image analysis and enhanced radiographic technology. This may further support clinical triage algorithms and help reduce medical complications in cases of foreign body ingestions.
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Affiliation(s)
- Johannes Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Christine Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany
| | - Joachim Voelker
- Department of Diagnostic and Interventional Radiology, St. Josef's Hospital Wiesbaden, Beethovenstr. 20, Wiesbaden, D-65189, Germany; Academic Teaching Hospital of Johannes Gutenberg University, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Jonas Engert
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany
| | - Phillipp Schendzielorz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany
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Oliva S, Romano C, De Angelis P, Isoldi S, Mantegazza C, Felici E, Dabizzi E, Fava G, Renzo S, Strisciuglio C, Quitadamo P, Saccomani MD, Bramuzzo M, Orizio P, Nardo GD, Bortoluzzi F, Pellegrino M, Illiceto MT, Torroni F, Cisarò F, Zullo A, Macchini F, Gaiani F, Raffaele A, Bizzarri B, Arrigo S, De' Angelis GL, Martinelli M, Norsa L. Foreign body and caustic ingestions in children: A clinical practice guideline. Dig Liver Dis 2020; 52:1266-1281. [PMID: 32782094 DOI: 10.1016/j.dld.2020.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
Foreign body and caustic ingestions in children are usually the most common clinical challenges for emergency physicians, general pediatricians and pediatric gastroenterologists. Management of these conditions often requires different levels of expertise and competence. Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect timing and indications. The imprecise clinical history frequently leaves clinicians uncertain about timing and nature of the ingestion. Few clinical guidelines regarding management of these ingestions in children have been published, none of which from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working Group to produce the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body and caustic ingestions. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed the project since many adult endoscopists usually manage children with these conditions. Differently from the other published guidelines, the proposed one focuses on the role of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists) in the diagnostic process of children with foreign body and caustic ingestions.
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Affiliation(s)
- Salvatore Oliva
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy.
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology and Pediatrics, University of Messina, Italy
| | - Paola De Angelis
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Isoldi
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Cecilia Mantegazza
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics and Pediatric Surgery, University of Milan, Buzzi Children's hospital, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Emanuele Dabizzi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | | | - Matteo Bramuzzo
- Pediatric Gastroenterology, Digestive Endoscopy and Clinical Nutrition Unit, Department of Pediatric, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital
| | | | - Maristella Pellegrino
- Pediatric Surgery Unit, Maternal and Child Department, ASST GOM of Niguarda, Milan, Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics, "Santo Spirito" Hospital of Pescara, Italy
| | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child health, IRCCS Policlinico San Matteo Pavia and Department of Clinical-Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy
| | - Gian Luigi De' Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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Torrecillas V, Meier JD. History and radiographic findings as predictors for esophageal coins versus button batteries. Int J Pediatr Otorhinolaryngol 2020; 137:110208. [PMID: 32896338 DOI: 10.1016/j.ijporl.2020.110208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine if clinical history and radiographic findings are reliable predictors for coin versus button battery in children presenting with esophageal foreign bodies to accurately guide decision making regarding the urgency of removal. METHODS A retrospective chart review was conducted in a single pediatric tertiary care center of all children who presented with suspected coin or button battery esophageal foreign body ingestion from 2017 to 2019. Patients with documented surgical removal, completed consultation notes, and available radiographic studies were included. Descriptive statistical analysis was performed and predictive characteristics of the diagnostic tests were calculated. RESULTS 139 patients met inclusion criteria for the study. Of 5 patients who had esophageal button batteries removed, clinical history was concerning for button battery in 2; accuracy of 12.35%. However, radiology reports suggested a battery in all 5. The negative predictive value for radiology alone for diagnosis of button battery was 97% with 81% accuracy. The clinical history for coin foreign body was accurate in 85.28% while radiography was 87% accurate. Wait time on average for all coin foreign body cases was 6.3 h. Day cases waited on average 5.5 h while after-hours cases waited a statistically significantly longer 7.5 h (p = 0.006). CONCLUSION Button batteries, while clinically important emergencies, are rare esophageal ingestions. Radiography has a strong negative predictive value for button battery. Children whose radiographic studies do not demonstrate concern for button battery could be considered for delayed elective removal. This could allow children to complete a period of observation at home, thereby reducing prolonged in-house wait times prior to operative removal.
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Anand S, Jain V, Agarwala S, Dhua AK, Yadav DK. Esophageal Button Battery in the Pediatric Population: Experience from a Tertiary Care Center. Indian J Pediatr 2020; 87:591-597. [PMID: 32062820 DOI: 10.1007/s12098-020-03222-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To highlight different patterns of clinical presentation, share authors' experience in the management of children following button battery ingestion and their outcomes. METHODS This is a single center descriptive cohort study with a total duration of 5 y (January 2014 through December 2018). Battery removal was performed by urgent rigid esophagoscopy following department protocols. Outcomes and complications were observed in the post-operative period in all children. Contrast esophagogram was performed at 4-6 wk post battery removal for assessing esophageal emptying and detecting sequelae (stricture). RESULTS Fifty-two children (M:F = 31:21) with a mean age (+SD) at presentation of 47 (+27) mo were managed at authors' center during the study period. Most common source of button battery was electronic appliance remote (50%) and common symptoms at presentation were vomiting after feeds, dysphagia, chest pain etc. During endoscopic retrieval, majority (60%) of the batteries were lodged in the upper esophagus and predominant impaction was noticed at anterior wall (81%) of esophagus. Upon injury assessment, grade 3 followed by grade 2 were detected in 59% and 41% cases respectively. Five children developed complications. Two deaths due to catastrophic hemorrhage (aorto-esophageal fistula) and refractory sepsis (tracheoesophageal fistula) occurred in present cohort. While contrast esophagogram was normal in all survivors, self-limiting symptoms like mild chest pain during swallowing and cough were observed during the follow-up. Median (IQR) duration of hospital stay and follow-up were 2 d (1-2.75) and 14.5 mo (8.5-17.5) respectively. CONCLUSIONS Accidental button battery ingestion can be life-threatening. Diagnosis is often delayed due to non-specific clinical presentation and unwitnessed ingestions. Esophagoscopic retrieval is the treatment modality of choice. Despite having significant esophageal injury at the time of removal, no long-term sequelae (clinical or radiological) were observed in present study.
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Affiliation(s)
- Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Kumar Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sancaktar ME, Bakırtaş M. A potential post-removal pH neutralization strategy to mitigate nasal button battery injuries. Int J Pediatr Otorhinolaryngol 2020; 133:110011. [PMID: 32222579 DOI: 10.1016/j.ijporl.2020.110011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Button batteries (BBs) impacted in the nose of children can cause septal perforation, synechia, atrophy, necrosis and deformities such as saddle nose. Developing mitigation strategies that can reduce tissue damage after BB removal can decrease these complications. METHODS 3 V lithium BBs were placed on the cadaveric sheep nasal septum model segments. After 3, 6, 12 and 24 h, BB on each segment was removed and intermittent irrigation was performed with 0.25% acetic acid solution. Irrigation with saline was performed as the control. Visual tissue damage that occurred just before and after irrigation was photographed. BB voltage, temperature and pH changes in the tissue were recorded. Each segment was examined after irrigation for the depth of necrosis and presence of cartilage necrosis. RESULTS The voltage of 3 V lithium BB was observed to drop to about half at the end of the 3rd hour. It was observed that full-thickness mucoperichondrial necrosis occurred in the nasal septum segments at all time points. Although 0.25% acetic acid irrigation significantly decreased tissue pH compared to saline without increasing temperature, it did not show a significant superiority compared to saline in reducing neither visually nor histologically damage. While cartilage necrosis was not observed for the first 12 h, it was measured 105 μm in the segment irrigated with 0.25% acetic acid at the end of 24 h, and 518 μm in the segment irrigated with saline. CONCLUSIONS The pH neutralization strategy with post-removal 0.25% acetic acid irrigation to mitigate nasal BB injury appears to be ineffective in reducing the full-thickness mucoperichondrial necrosis starting within 3 h. Although this strategy seems to decrease the progression of cartilage necrosis starting after 12 h, the development of pre-removal strategies for the first 3 h may be more effective and superior in reducing mucoperichondrial damage.
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Affiliation(s)
- Mehmet Eser Sancaktar
- Ministry of Health, University of Medical Sciences, Samsun Training and Research Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Samsun, Turkey.
| | - Mustafa Bakırtaş
- Ministry of Health, University of Medical Sciences, Samsun Training and Research Hospital, Department of Pathology, Samsun, Turkey.
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Meyer TJ, Grunz JP, Taeger J, Rak K, Hagen R, Hackenberg S, Völker J, Scherzad A. Systematic analysis of button batteries', euro coins', and disk magnets' radiographic characteristics and the implications for the differential diagnosis of round radiopaque foreign bodies in the esophagus. Int J Pediatr Otorhinolaryngol 2020; 132:109917. [PMID: 32032915 DOI: 10.1016/j.ijporl.2020.109917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Button battery (BB) ingestion can cause life-threatening complications such as esophageal perforation, and mediastinitis. Chest radiography is the method of choice to diagnose BB ingestion. Therefore, an adequate interpretation of X-ray imaging by physicians is mandatory. The study aimed to analyze relevant diagnostic aspects of BB X-ray imaging, and retrospective analysis of the imaging of radiopaque foreign bodies. METHODS All commercially available BBs and different foreign bodies such as euro coins (EC) and disk magnets (DM) were listed according to their sizes and compositions. Furthermore, an X-ray analysis of a test set of BBs, ECs and DMs was performed at angles of 0°, 45°, and 90°. Retrospective assessment of radiological characteristics was performed for patients with a round and radiopaque foreign body in the esophagus RESULTS: Only BBs with a diameter of at least 20 mm had a reliable positive double rim sign at scan angles of 90°, and 45°. The step-off effect was visible in all BBs regardless of the diameter. DMs and ECs presented a homogeneous X-ray weakening at all investigated scan angles. In the retrospective analysis all five cases of BB ingestion showed a double rim sign, all fifteen cases of coin ingestion a homogeneous X-ray weakening. A corrugated margin was detected for 10 cent, 20 cent and 50 cent coins. CONCLUSIONS BBs with a diameter of at least 20 mm showed, depending on the battery model, a more or less pronounced double rim sign and step-off effect in conventional X-ray imaging. However the double rim sign can be simulated by for example a pot magnet.
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Affiliation(s)
- Till Jasper Meyer
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Str. 6, Wuerzburg, D-97080, Germany.
| | - Johannes Taeger
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Stephan Hackenberg
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Johannes Völker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Agmal Scherzad
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
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Karnecki K, Pieśniak D, Jankowski Z, Gos T, Kaliszan M. Fatal haemorrhage from an aortoesophageal fistula secondary to button battery ingestion in a 15-month-old child. Case report and literature review. Leg Med (Tokyo) 2020; 45:101707. [PMID: 32305674 DOI: 10.1016/j.legalmed.2020.101707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/31/2020] [Accepted: 04/12/2020] [Indexed: 11/25/2022]
Abstract
Small children put various objects into their mouths, which is one of their ways of exploring the surrounding world. Apart from toy parts, e.g. Lego® bricks or magnetic spheres, such objects include coins, small stones, as well as batteries used for different electric devices. Such batteries, especially the flat, round button type, may be ingested and become impacted in one of the physiological narrowing sites of the oesophagus, leading to serious complications. The case of a 15-month-old child is presented, who died due to a massive gastrointestinal haemorrhage from an aortoesophageal fistula that developed at the site of a pressure ulcer caused by an impacted button battery. The presented case shows that ingestion of even a small battery may lead to death. The asymptomatic course of the battery ingestion significantly hinders both the assessment of circumstances and the time of the battery ingestion. Sudden death may result from a massive haemorrhage from a pressure-induced injury to a big blood vessel.
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Affiliation(s)
- Karol Karnecki
- Department of Forensic Medicine, Medical University of Gdańsk, ul. Dębowa 23, 80-204 Gdańsk, Poland
| | - Dorota Pieśniak
- Department of Forensic Medicine, Medical University of Gdańsk, ul. Dębowa 23, 80-204 Gdańsk, Poland
| | - Zbigniew Jankowski
- Department of Forensic Medicine, Medical University of Gdańsk, ul. Dębowa 23, 80-204 Gdańsk, Poland
| | - Tomasz Gos
- Department of Forensic Medicine, Medical University of Gdańsk, ul. Dębowa 23, 80-204 Gdańsk, Poland
| | - Michał Kaliszan
- Department of Forensic Medicine, Medical University of Gdańsk, ul. Dębowa 23, 80-204 Gdańsk, Poland.
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Shaffer AD, Jacobs IN, Derkay CS, Goldstein NA, Giordano T, Ho S, Kim BJ, Park AH, Simons JP. Management and Outcomes of Button Batteries in the Aerodigestive Tract: A Multi-institutional Study. Laryngoscope 2020; 131:E298-E306. [PMID: 32068903 DOI: 10.1002/lary.28568] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/30/2019] [Accepted: 01/26/2020] [Indexed: 11/09/2022]
Abstract
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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Affiliation(s)
- Amber D Shaffer
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ian N Jacobs
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Craig S Derkay
- Department of Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, Virginia
| | - Nira A Goldstein
- Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Terri Giordano
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sandra Ho
- Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Bong J Kim
- Division of Pediatric Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Albert H Park
- Division of Pediatric Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Jeffrey P Simons
- Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Gerner P, Pallacks F, Laschat M, Hermanns-Clausen M. [Health damages after ingestion of button batteries in childhood]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1354-1361. [PMID: 31620820 DOI: 10.1007/s00103-019-03029-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Exposure of children under 5 years to button batteries may result in severe corrosive injury, especially when they get stuck in the oesophagus. The injury is caused by the discharge current of the batteries. An increasing number of button battery ingestions have been described worldwide. OBJECTIVES The aim of this study was to describe incidence and complications after battery ingestion in children in Germany. MATERIALS AND METHODS Paediatric gastroenterologists and paediatric surgeons were asked to report complicated battery ingestions in children between 2011 and 2016 retrospectively. The survey was done using a structured questionnaire. In addition, button battery ingestion calls to a German poison centre were analysed retrospectively. RESULTS In 116 cases the button battery was located in the oesophagus. Severe complications developed in 47 patients and 5 of these children died. Serious complications occurred also in children with removal of the button batteries within less than 3 h after the intake. The Freiburg poison centre received 258 paediatric ingestions of button batteries. Out of these, seven button batteries were stuck in the oesophagus and five in the nose causing corrosion injury. CONCLUSIONS Serious complications and even death after button battery ingestion are described in Germany. Button batteries impacted in the oesophagus should be removed emergently to minimize corrosive injury. Because no symptoms or only slight discomfort are developed initially, awareness of button batteries as a unique corrosive hazard among the public and clinicians is an important requirement for prompt diagnosis and treatment resulting in a satisfactory outcome.
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Affiliation(s)
- Patrick Gerner
- Klinik für allgemeine Kinder- und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin (Departement), Universitätsklinikum Freiburg, Mathildenstr. 1, 79106, Freiburg, Deutschland
| | - Frauke Pallacks
- Klinik für Kinder- und Jugendmedizin, Klinikum Aschaffenburg, Aschaffenburg, Deutschland
| | - Michael Laschat
- Kinderkrankenhaus, Kliniken der Stadt Köln, Köln, Deutschland
| | - Maren Hermanns-Clausen
- Klinik für allgemeine Kinder- und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin (Departement), Universitätsklinikum Freiburg, Mathildenstr. 1, 79106, Freiburg, Deutschland.
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Whelan R, Shaffer A, Dohar JE. Button battery versus stacked coin ingestion: A conundrum for radiographic diagnosis. Int J Pediatr Otorhinolaryngol 2019; 126:109627. [PMID: 31404782 PMCID: PMC6825552 DOI: 10.1016/j.ijporl.2019.109627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Rachel Whelan
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, Pittsburgh, PA, USA.
| | - Amber Shaffer
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, Pittsburgh, PA, USA
| | - Joseph E Dohar
- Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, Pittsburgh, PA, USA
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Thakkar HS, Hewitt R, Cross K, Hannon E, De Bie F, Blackburn S, Eaton S, McLaren CA, Roebuck DJ, Elliott MJ, Curry JI, Muthialu N, De Coppi P. The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae. Pediatr Surg Int 2019; 35:97-105. [PMID: 30392126 PMCID: PMC6325990 DOI: 10.1007/s00383-018-4380-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/02/2022]
Abstract
AIM OF THE STUDY Complex tracheo-oesophageal fistulae (TOF) are rare congenital or acquired conditions in children. We discuss here a multidisciplinary (MDT) approach adopted over the past 5 years. METHODS We retrospectively collected data on all patients with recurrent or acquired TOF managed at a single institution. All cases were investigated with neck and thorax CT scan. Other investigations included flexible bronchoscopy and bronchogram (B&B), microlaryngobronchoscopy (MLB) and oesophagoscopy. All cases were subsequently discussed in an MDT meeting on an emergent basis if necessary. MAIN RESULTS 14 patients were referred during this study period of which half had a congenital aetiology and the other half were acquired. The latter included button battery ingestions (5/7) and iatrogenic injuries during oesophageal atresia (OA) repair. Surgical repair was performed on cardiac bypass in 3/7 cases of recurrent congenital fistulae and all cases of acquired fistulae. Post-operatively, 9/14 (64%) patients suffered complications including anastomotic leak (1), bilateral vocal cord paresis (1), further recurrence (1), and mortality (1). Ten patients continue to receive surgical input encompassing tracheal/oesophageal stents and dilatations. CONCLUSIONS MDT approach to complex cases is becoming increasingly common across all specialties and is important in making decisions in these difficult cases. The benefits include shared experience of rare cases and full access to multidisciplinary expertise.
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Affiliation(s)
- H. S. Thakkar
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - R. Hewitt
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK ,Tracheal Team, Great Ormond Street Hospital, London, UK
| | - K. Cross
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - E. Hannon
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - F. De Bie
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK ,General Surgery Resident, KU Leuven, Leuven, Belgium
| | - S. Blackburn
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - S. Eaton
- Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - C. A. McLaren
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - D. J. Roebuck
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - M. J. Elliott
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - J. I. Curry
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - N. Muthialu
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - P. De Coppi
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK ,Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK
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Huang T, Li WQ, Xia ZF, Li J, Rao KC, Xu EM. Characteristics and outcome of impacted button batteries among young children less than 7 years of age in China: a retrospective analysis of 116 cases. World J Pediatr 2018; 14:570-575. [PMID: 30328588 DOI: 10.1007/s12519-018-0188-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ingestion of button batteries occurs in about ten persons per one million persons each year, with most of them children, and one in every 1000 battery ingestions leads to serious injuries. This study aimed to describe the clinical features and outcome of ingestion or inhalation of button batteries in children spanning a decade from January, 2006 to December, 2016 at a tertiary care hospital. METHODS We reviewed the clinical records of children who sought treatment for inhaled or ingested button batteries at our hospital during the study period. Data on gender, age, time from ingestion to treatment, site of impaction, imaging findings, and outcomes were retrieved and analyzed. RESULTS We identified 116 pediatric cases of ingestion or inhalation of button batteries. Their mean age was 26 months. The time from ingestion or inhalation of button batteries to treatment was 0.5 hours to 2 weeks. Ninety-seven (83.6%) button batteries were located in the nasal cavity, 13 (11.2%) in the gastrointestinal (GI) tract including 6 in the esophagus, and 7 in the stomach and lower GI tract, and 6 (5.2%) in the auditory tract. Twenty-one (21.6%) children with nasal button batteries had preoperative septal perforations and one (1.0%) had postoperative septal perforation. One child with esophageal button battery developed esophageal stricture and one died of sudden cardiac arrest perioperatively. One child had auditory damages in the right tympanic membrane and ossicles. CONCLUSIONS Inhalation or ingestion may occur in the nasal cavities, the esophagus and GI tract and the auditory tract. Prompt diagnosis and treatment are required for a satisfactory outcome and ingested or inhaled button batteries require different treatment protocols.
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Affiliation(s)
- Tao Huang
- Department of ENT, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
| | - Wen-Qing Li
- Department of Respiratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, No. 100 Jiangan District, Wuhan 430016, China.
| | - Zhong-Fang Xia
- Department of ENT, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
| | - Jun Li
- Department of ENT, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
| | - Kai-Cheng Rao
- Department of ENT, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
| | - En-Ming Xu
- Department of ENT, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
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Soto PH, Reid NE, Litovitz TL. Time to perforation for button batteries lodged in the esophagus. Am J Emerg Med 2018; 37:805-809. [PMID: 30054113 DOI: 10.1016/j.ajem.2018.07.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION New strategies recently proposed to mitigate injury caused by lithium coin cell batteries lodged in the esophagus include prehospital administration of honey to coat the battery and prevent local hydroxide generation and in-hospital administration of sucralfate suspension (or honey). This study was undertaken to define the safe interval for administering coating agents by identifying the timing of onset of esophageal perforations. METHODS A retrospective study of 290 fatal or severe battery ingestions with esophageal lodgment was undertaken to identify cases with esophageal perforations. RESULTS Esophageal perforations were identified in 189 cases (53 fatal, 136 severe; 95.2% in children ≤4 years). Implicated batteries were predominantly lithium (91.0%) and 92.0% were ≥20 mm diameter. Only 2% of perforations occurred in <24 h following ingestion, including 3 severe cases with perforations evident at 11-17 h, 12 h, and 18 h. Another 7.4% of perforations (11 cases) became evident 24 to 47 h post ingestion and 10.1% of perforations (15 cases) became evident 48 to 71 h post ingestion. By 3 days post ingestion, 26.8% of perforations were evident, 36.9% by 4 days, 46.3% by 5 days, and 66.4% by 9 days. CONCLUSION Esophageal perforation is unlikely in the 12 h after battery ingestion, therefore the administration of honey or sucralfate carries a low risk of extravasation from the esophagus. This first 12 h includes the period of peak electrolysis activity and battery damage, thus the risk of honey or sucralfate is low while the benefit is likely high.
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Affiliation(s)
- Pelayia H Soto
- National Capital Poison Center, Washington, DC, United States; Department of Emergency Medicine, The George Washington University School of Medicine, Washington, DC, United States
| | - Nicole E Reid
- National Capital Poison Center, Washington, DC, United States; Department of Emergency Medicine, The George Washington University School of Medicine, Washington, DC, United States
| | - Toby L Litovitz
- National Capital Poison Center, Washington, DC, United States; Department of Emergency Medicine, The George Washington University School of Medicine, Washington, DC, United States; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, United States.
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Krom H, Visser M, Hulst JM, Wolters VM, Van den Neucker AM, de Meij T, van der Doef HPJ, Norbruis OF, Benninga MA, Smit MJM, Kindermann A. Serious complications after button battery ingestion in children. Eur J Pediatr 2018; 177:1063-1070. [PMID: 29717359 PMCID: PMC5997112 DOI: 10.1007/s00431-018-3154-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 01/08/2023]
Abstract
UNLABELLED Serious and fatal complications after button battery ingestion are increasing worldwide. The aim of this study is to describe serious complications after battery ingestion in children in the Netherlands.All pediatric gastroenterologists in the Netherlands performing upper endoscopies were asked to report all serious complications after battery ingestion in children (0-18 years) between 2008 and 2016 retrospectively.Sixteen serious complications were reported: death after massive bleeding through esophageal-aortal fistula (n = 1), esophageal-tracheal fistula (n = 5), stenosis after (suspected) perforation and mediastinitis (n = 5), (suspected) perforation and mediastinitis (n = 3), vocal cord paralysis (n = 1), and required reintubation for dyspnea and stridor (n = 1). The median time interval between ingestion and presentation was 5 (IQR 2-258) h. All children were ≤ 5 (median 1.4; IQR 0.9-2.1) years. Vomiting (31.3%), swallowing/feeding problems (31.3%), and fever (31.3%) were the most common presenting symptoms; however, 18.8% of the patients were asymptomatic (n = 1 missing). All batteries were button batteries (75% ≥ 20 mm; 18.8% < 20 mm; n = 1 missing). The batteries were removed by esophagogastroduodenoscopy (50%) and rigid endoscopy (37.5%) or surgically (12.5%). CONCLUSION Sixteen serious complications occurred after small and large button batteries ingestion between 2008 and 2016 in both symptomatic and asymptomatic children in the Netherlands. Therefore, immediate intervention after (suspected) button battery ingestion is required. What is Known: • Button battery ingestion may result in serious and fatal complications. • Serious and fatal complications after button battery ingestion are increasing worldwide. What is New: • Sixteen serious complications after button battery ingestion occurred during 2008-2016 in children in the Netherlands. • Serious complications were also caused by small batteries (< 20 mm) in the Netherlands and also occurred in asymptomatic Dutch children.
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Affiliation(s)
- Hilde Krom
- Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands.
| | - Margot Visser
- Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Jessie M. Hulst
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Victorien M. Wolters
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Tim de Meij
- VU University Medical Center, Amsterdam, Netherlands
| | | | | | - Marc A. Benninga
- Emma Children’s Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Margot J. M. Smit
- Juliana Children’s Hospital, Haga Teaching Hospital, Den Haag, Netherlands
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Follent AM, Rumbach AF, Ward EC, Marshall J, Dodrill P, Lewindon P. Dysphagia and feeding difficulties post-pediatric ingestion injury: Perspectives of the primary caregiver. Int J Pediatr Otorhinolaryngol 2017; 103:20-28. [PMID: 29224759 DOI: 10.1016/j.ijporl.2017.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 08/12/2017] [Accepted: 09/11/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore the experiences of children with dysphagia and/or feeding difficulties post-chemical or button battery ingestion injury from the perspective of the primary caregiver. METHOD Five primary caregivers of children with a history of dysphagia and/or feeding difficulties post-ingestion injury (4 chemical, 1 button battery) completed the Children's Picky Eating Questionnaire (CPEQ), and participated in a semi-structured interview. Interviews explored experiences of caring for a child with dysphagia and/or feeding difficulties, impressions of services and supports, and additional impacts to the child and family. Content analysis was used to identify key themes. RESULT Primary caregiver report and CPEQ results confirmed all children had some degree of persisting dysphagia and/or feeding difficulties at time of interview (mean 4.13 years' post-injury). Interviews identified five key themes: 1) The initial trauma of the injury, 2) The experience of associated and ongoing medical issues, 3) Managing altered oral intake, 4) Experiences of services and support, and 5) Impacts on the child, primary caregiver, and wider family unit. All caregivers reported significant challenges and concerns, and potential areas of service improvement were highlighted. CONCLUSION The current data highlights specific issues experienced by primary caregivers, and poses areas for improving primary caregiver and family supports. Family-centered models of care are needed to support the whole family unit in caring for a child with dysphagia and/or feeding difficulties post-ingestion injury.
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Affiliation(s)
- Anna M Follent
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072 Australia.
| | - Anna F Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072 Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072 Australia; Centre for Functioning and Health Research, PO Box 6053, Buranda, QLD 4102 Australia
| | - Jeanne Marshall
- Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, QLD 4101 Australia
| | - Pamela Dodrill
- Department of Otolaryngology, Feeding and Swallowing Program, Boston Children's Hospital, Boston, USA
| | - Peter Lewindon
- Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, QLD 4101 Australia
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Nazir Z, Khan MAM, Qamar J. Recurrent and acquired tracheoesophageal fistulae (TEF)-Minimally invasive management. J Pediatr Surg 2017; 52:1688-1690. [PMID: 28365107 DOI: 10.1016/j.jpedsurg.2017.03.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/09/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Recurrent and acquired fistulae are a serious complication of congenital esophageal atresia and tracheoesophageal fistula (TEF) repair and foreign body ingestion (FBI) (e.g., button battery). We report our experience with a minimally invasive approach to recurrent and acquired TEF. METHODS Medical records of patients referred for management of recurrent and acquired TEF between 2003 and 2015 were reviewed retrospectively. Patients underwent endoscopic procedures (de-epithelization of fistulous tract and fibrin tissue adhesive-TisseelR) under general anesthesia. RESULTS Nine children (7 male, 2 female) with age range 3months to 3years (mean 1.5year) were managed. TEF closed spontaneously in four patients, whereas in 5 patients the TEF closed after combined endoscopic procedure. Three patients required repeat endoscopic procedures. Follow-up ranged between 7months to 10years (mean 4.2years). CONCLUSIONS Active observation and repeat combined endoscopic procedures are safe alternatives to open surgical repair of acquired and recurrent TEF. LEVEL OF EVIDENCE Level IV study.
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Affiliation(s)
- Zafar Nazir
- Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan.
| | - Muhammad Arif Mateen Khan
- Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan
| | - Javaria Qamar
- Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan
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Jayasuriya NSS, Karunathilaka PRCL, Wijekoon P. An unusual foreign object mimicking an odontoma in a patient with cleft alveolus: a case report. J Med Case Rep 2017; 11:279. [PMID: 28946895 PMCID: PMC5613624 DOI: 10.1186/s13256-017-1433-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background The habit of inserting foreign objects into body cavities is seen in children and in adults with intellectual disability. Usually, the foreign objects cause chronic inflammation and local tissue destruction, which give rise to symptoms. Diagnosis at an asymptomatic stage is uncommon when the history is not suggestive. We describe a rare case where a foreign object was misdiagnosed as an odontoma in a patient with an alveolar cleft. Case presentation A radiopaque round mass was noted on the radiograph of a 12-year-old Sinhalese boy who was awaiting an alveolar bone graft. Apart from problems related to the alveolar cleft and mild halitosis, he was otherwise healthy. This was suspected to be an odontoma in the cleft region. During alveolar bone graft surgery, a button battery was recovered that was later confirmed as having been self-inserted by the child. Alveolar bone graft surgery was delayed because of local chronic inflammation due to the foreign object. Three months later, complete healing of the site was noted when reexplored for alveolar bone grafting. Conclusions It is important to include foreign objects in the radiological differential diagnosis in asymptomatic children. Furthermore, cone beam computed tomography should be considered in suspected cases. Early removal with thorough debridement causes minimal tissue destruction.
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Affiliation(s)
| | | | - Parakrama Wijekoon
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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Lee EJ, Yang HR, Cho JM, Ko JS, Moon JS. Two Cases of Colonoscopic Retrieval of a Foreign Body in Children: A Button Battery and an Open Safety Pin. Pediatr Gastroenterol Hepatol Nutr 2017; 20:204-209. [PMID: 29026738 PMCID: PMC5636938 DOI: 10.5223/pghn.2017.20.3.204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 12/15/2022] Open
Abstract
Ingestion of foreign body in children is a relatively common problem among paediatric population. The foreign bodies mostly pass spontaneously through the gastrointestinal tract. However, complications can occur according to its anatomical location, the characteristics of the foreign body, and delays in management. Although the cases of ingested button batteries or sharp objects impacted at the gastrointestinal tract can be very serious, there have been very only a few cases have reported colonoscopic removal of these dangerous foreign bodies in adults, and there have been no case reports in children. We report one case of a button battery and one case of an open safety pin, both impacted in the terminal ileum that had moved from the stomach within a few hours of ingestion and were eventually managed by colonoscopy without any complications.
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Affiliation(s)
- Eun Joo Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Min Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Zhang Z, Ma J, Liu S, Liu X, Yan X, Niu T, Li C, Li Q, Wang C, Meng C. Fully-covered metallic stenting in an infant with tracheoesophageal fistula due to button battery ingestion. Int J Pediatr Otorhinolaryngol 2017; 95:80-83. [PMID: 28576539 DOI: 10.1016/j.ijporl.2017.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/29/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
Previously, the main treatment options for tracheoesophageal fistula included surgery and conservative treatment. Herein, we report a child suffering from severe tracheoesophageal fistula due to button battery ingestion. The child relapsed soon after a repair surgery. Then, he was endotracheally implanted with a fully-covered metallic stent combined with a jejunal tube feeding. He recovered soon and the stent was removed five months later. The fistula was healed with no relapse during a 25-month follow-up. Therefore, endotracheal implantation of fully-covered metallic stent is an alternative treatment for tracheoesophageal fistula due to button battery ingestion, especially in cases with severe respiratory disorders.
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Affiliation(s)
- Zhongxiao Zhang
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Jing Ma
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Shuaishuai Liu
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Xia Liu
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Xiuli Yan
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Tiehuan Niu
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Changxiao Li
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Qian Li
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Chao Wang
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Chen Meng
- Department of Respiratory Intervention, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China.
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44
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Kim J, Ahn JY, So S, Lee M, Oh K, Jung HY. Fluoroscopy-Guided Endoscopic Removal of Foreign Bodies. Clin Endosc 2016; 50:197-201. [PMID: 28008164 PMCID: PMC5398372 DOI: 10.5946/ce.2016.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 01/08/2023] Open
Abstract
In most cases of ingested foreign bodies, endoscopy is the first treatment of choice. Moreover, emergency endoscopic removal is required for sharp and pointed foreign bodies such as animal or fish bones, food boluses, and button batteries due to the increased risks of perforation, obstruction, and bleeding. Here, we presented two cases that needed emergency endoscopic removal of foreign bodies without sufficient fasting time. Foreign bodies could not be visualized by endoscopy due to food residue; therefore, fluoroscopic imaging was utilized for endoscopic removal of foreign bodies in both cases.
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Affiliation(s)
- Junhwan Kim
- Department of Internal Medicine, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seol So
- Department of Internal Medicine, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mingee Lee
- Department of Internal Medicine, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyunghwan Oh
- Department of Internal Medicine, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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45
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Jatana KR, Rhoades K, Milkovich S, Jacobs IN. Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal. Laryngoscope 2016; 127:1276-1282. [PMID: 27859311 DOI: 10.1002/lary.26362] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/28/2016] [Accepted: 09/09/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES/HYPOTHESIS Button battery (BB) injuries continue to be a significant source of morbidity and mortality, and there is a need to confirm the mechanism of injury for development of additional mitigation strategies. STUDY DESIGN Cadaveric piglet esophageal model. METHODS Lithium, silver oxide, alkaline, and zinc-air BBs were placed in thawed sections of cadaveric piglet esophagus, bathed in normal saline. Severity of gross visual burn, pH, and temperature were recorded every 30 minutes for 6 hours. In other esophageal tissue specimens, the lithium BB was removed after 24, 36, and 48 hours and the site was irrigated with either 0.25% or 3% acetic acid. Separately, ReaLemon® juice, orange juice, Coke®, Dasani® water, Pepsi®, and saline were infused over a vertically suspended esophagus with a CR2032 lithium battery every 5 minutes for 2 hours while tissue temperature and pH were measured. RESULTS A gradual rise in tissue pH and minimal change in temperature was noted for all BBs. ReaLemon® and orange juice applied every 5 minutes were most effective at neutralization of tissue pH with minimal change in tissue temperature. After BB removal (24, 36, 48 hours), irrigation of esophageal tissue specimens with 50-150 mL 0.25% acetic acid neutralized the highly alkaline tissue pH. CONCLUSIONS BB appear to cause an isothermic hydrolysis reaction resulting in an alkaline caustic injury. Potential new mitigation strategies include application of neutralizing weakly acidic solutions that may reduce esophageal injury progression. LEVEL OF EVIDENCE NA Laryngoscope, 127:1276-1282, 2017.
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Affiliation(s)
- Kris R Jatana
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital and Wexner Medical Center at Ohio State University, Columbus, Ohio, U.S.A
| | - Keith Rhoades
- Intertek Product Intelligence Group, Oak Brook, Illinois, U.S.A
| | - Scott Milkovich
- Intertek Product Intelligence Group, Oak Brook, Illinois, U.S.A
| | - Ian N Jacobs
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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46
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Eliason MJ, Melzer JM, Winters JR, Gallagher TQ. Identifying predictive factors for long-term complications following button battery impactions: A case series and literature review. Int J Pediatr Otorhinolaryngol 2016; 87:198-202. [PMID: 27368471 DOI: 10.1016/j.ijporl.2016.06.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To complement a case series review of button battery impactions managed at our single military tertiary care center with a thorough literature review of laboratory research and clinical cases to develop a protocol to optimize patient care. Specifically, to identify predictive factors of long-term complications which can be used by the pediatric otolaryngologist to guide patient management after button battery impactions. METHODS A retrospective review of the Department of Defense's electronic medical record systems was conducted to identify patients with button battery ingestions and then characterize their treatment course. A thorough literature review complemented the lessons learned to identify potentially predictive clinical measures for long-term complications. RESULTS Eight patients were identified as being treated for button battery impaction in the aerodigestive tract with two sustaining long-term complications. The median age of the patients treated was 33 months old and the median estimated time of impaction in the aerodigestive tract prior to removal was 10.5 h. Time of impaction, anatomic direction of the battery's negative pole, and identifying specific battery parameters were identified as factors that may be employed to predict sequelae. CONCLUSION Based on case reviews, advancements in battery manufacturing, and laboratory research, there are distinct clinical factors that should be assessed at the time of initial therapy to guide follow-up management to minimize potential catastrophic sequelae of button battery ingestion.
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Affiliation(s)
- Michael J Eliason
- Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
| | - Jonathan M Melzer
- Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
| | - Jessica R Winters
- Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
| | - Thomas Q Gallagher
- Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
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Parker K, Visram S, Hodges S. An incidental finding of a long-standing button battery in the floor of the nose during a routine orthodontic examination. J Orthod 2016; 43:147-50. [PMID: 27164470 DOI: 10.1080/14653125.2016.1158346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Foreign body insertion into the ears and nose is common in children and is often witnessed by the carer or reported by the child and therefore appropriate management can be sought promptly. However, these incidents can go unreported and may be accompanied by non-specific symptoms making diagnosis difficult. Button batteries are common in everyday life and their small size and shiny appearance make them appealing to children and their ingestion or insertion is not uncommon. Due to their size, shape and electrochemical composition button batteries pose serious complications if ingested, inhaled or inserted. In the nose they usually cause intense local tissue reactions resulting in severe tissue destruction, septal necrosis or stenosis of the nasal cavity as well as posing the risk of subsequently being ingested or aspirated. This case report details an incidental finding of a button battery in the floor of the nose discovered on routine orthodontic radiographs. An upper standard occlusal and dental panoramic tomography showed a radiopaque, cylindrical, object in the floor of the nose which a subsequent CBCT localized to the floor of the right nasal fossa. The patient required orthodontic extractions and the exposure and bonding of teeth under general anaesthetic. Therefore the battery was removed by the maxillofacial surgery team at the same general anaesthetic. This is a rare case of an incidental finding of a long-standing button battery impaction which was asymptomatic and did not have any detrimental effects. This case highlights the dangers of button battery impaction and the need for prompt referral for removal.
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Affiliation(s)
- Kate Parker
- a Eastman Dental Hospital , 256 Gray's Inn Road, London WC1X 8LD , UK
| | - Semina Visram
- b Orthodontic Birmingham Dental Hospital , St Chad's Queensway, Birmingham B4 6NN , UK
| | - Samantha Hodges
- a Eastman Dental Hospital , 256 Gray's Inn Road, London WC1X 8LD , UK
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48
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Lee JH, Lee JH, Shim JO, Lee JH, Eun BL, Yoo KH. Foreign Body Ingestion in Children: Should Button Batteries in the Stomach Be Urgently Removed? Pediatr Gastroenterol Hepatol Nutr 2016; 19:20-8. [PMID: 27066446 PMCID: PMC4821979 DOI: 10.5223/pghn.2016.19.1.20] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/23/2015] [Accepted: 10/04/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Foreign body (FB) ingestion is common in children, and button battery (BB) ingestion has been increasing in recent years. This study was to identify factors related to outcomes of FB ingestion, particularly BBs in the stomach. We evaluated whether the current recommendations are appropriate and aimed to suggest indications for endoscopic removal of BB in the stomach in young children. METHODS We investigated patient age, shape, size, location of FBs, spontaneous passage time and resulting complications among 76 children. We observed types, size, location of BB and outcomes, and analyzed their associations with complications. RESULTS Coins and BB were the two most common FBs. Their shapes and sizes were not associated with the spontaneous passage time. Size, spontaneous passage time, and age were also not associated with any specific complications. For BB ingestion, all 5 cases with lithium batteries (≥1.5 cm, 3 V) presented moderate to major complications in the esophagus and stomach without any symptoms, even when the batteries were in the stomach and beyond the duodenum, while no complications were noted in 7 cases with alkaline batteries (<1.5 cm, 1.5 V) (p=0.001). All endoscopies were conducted within 24 hours after ingestion. CONCLUSION The type and voltage of the battery should be considered when determining whether endoscopy is required to remove a BB in the stomach. For lithium battery ingestion in young children, urgent endoscopic removal might be important in order to prevent complications, even if the child is asymptomatic and the battery is smaller than 2 cm.
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Affiliation(s)
- Jun Hee Lee
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jee Hoo Lee
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Ok Shim
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Hwa Lee
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Baik-Lin Eun
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Yoo
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Abstract
Oesophageal foreign bodies (FBs) are commonly encountered in an otolaryngology setting. The majority of such cases remain in the paediatric population, where obtaining an accurate history of events is challenging. Oesophageal FBs present in a variety of ways other than dysphagia, which may result in delayed presentation, diagnosis and subsequent treatment. Where an ingested FB is a battery, early removal is advocated owing to the potential for significant complications, a problem highlighted by a patient safety alert issued by NHS England. A common paediatric presentation, torticollis has a multitude of potential underlying causes. We present an unusual case of torticollis in a two-year old girl, subsequently revealed to be caused by an ingested button battery.
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Affiliation(s)
- J M Walton
- Northampton General Hospital NHS Trust , UK
| | - A Darr
- Walsall Healthcare NHS Trust , UK
| | - A George
- University Hospitals of North Midlands NHS Trust , UK
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50
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Guinet T, Gaulier JM, Moesch C, Bagur J, Malicier D, Maujean G. Sudden death following accidental ingestion of a button battery by a 17-month-old child: a case study. Int J Legal Med 2016; 130:1291-7. [PMID: 26886106 DOI: 10.1007/s00414-016-1329-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
Cases of ingesting button batteries by children are not common clinical situations in forensic medicine. Although it can be a cause of death when associated with digestive perforations, no cases of sudden death have been reported in the literature. We report the case of a 17-month-old girl who presented at home with haematemesis, followed by failed cardiopulmonary resuscitation. The child had been treated on two occasions for nasopharyngitis, 14 and 18 days prior to her death. The post-mortem scan revealed a radio-opaque foreign body in the oesophagus. The autopsy revealed the presence of a round button battery, 20 mm in diameter, blocking the lumen of the oesophagus in its upper third, associated with two parietal oesophageal ruptures opposite each other. There was limited digestive haemorrhage, but above all significant bronchial inhalation of blood. Toxicology analyses showed slightly increased blood levels of the heavy metals of which the battery was composed (lithium, chromium, manganese and molybdenum). The anatomopathological analyses confirmed the recent nature of these ruptures. Ingestions of button batteries localised at the level of the oesophagus are the cases linking to the highest risk of complications, particularly for batteries with a diameter of more than 20 mm and in children under the age of 4. The main difficulty in such clinical situations is identifying when the ingestion occurred, as more often than not, no witnesses are present. We discuss the advantages of anatomopathology and toxicology examinations targeted towards heavy metals in these forensic situations.
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Affiliation(s)
- T Guinet
- Institut de Médecine Légale, Département de Médecine Légale, Hôpital Edouard Herriot, Hospices civils de Lyon, 12 Avenue Rockefeller, Lyon, France.
- Unité médico-judiciaire, Hôpital Edouard Herriot, Hospices civils de Lyon, Place d'Arsonval, 69003, Lyon, France.
| | - J M Gaulier
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, Hôpital Dupuytren, Limoges, France
- Unité Fonctionnelle de Toxicologie, Pôle de Biologie-Pathologie-Génétique, CHRU de Lille, Lille, France
| | - C Moesch
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, Hôpital Dupuytren, Limoges, France
| | - J Bagur
- Unité médico-judiciaire, Hôpital Edouard Herriot, Hospices civils de Lyon, Place d'Arsonval, 69003, Lyon, France
| | - D Malicier
- Institut de Médecine Légale, Département de Médecine Légale, Hôpital Edouard Herriot, Hospices civils de Lyon, 12 Avenue Rockefeller, Lyon, France
- Unité médico-judiciaire, Hôpital Edouard Herriot, Hospices civils de Lyon, Place d'Arsonval, 69003, Lyon, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Université de Lyon, Chemin du Grand Revoyet, Pierre Bénite, 69310, France
| | - G Maujean
- Institut de Médecine Légale, Département de Médecine Légale, Hôpital Edouard Herriot, Hospices civils de Lyon, 12 Avenue Rockefeller, Lyon, France
- Unité médico-judiciaire, Hôpital Edouard Herriot, Hospices civils de Lyon, Place d'Arsonval, 69003, Lyon, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Université de Lyon, Chemin du Grand Revoyet, Pierre Bénite, 69310, France
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