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20 mm lithium button battery causing an oesophageal perforation in a toddler: lessons in diagnosis and treatment
  1. Giampiero Soccorso1,
  2. Ole Grossman1,
  3. Massimo Martinelli2,
  4. Sean S Marven1,
  5. Kirtik Patel3,
  6. Mike Thomson4,
  7. Julian P Roberts1
  1. 1Paediatric Surgery Unit, Sheffield Children's NHS Foundation Trust, Sheffield, UK
  2. 2Department of Paediatrics, University of Naples Federico II, Napoli, Italy
  3. 3Adult Upper GI Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
  4. 4Centre for Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Giampiero Soccorso, Paediatric Surgery Unit, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire S10 2TH, UK; giampsoccorso{at}doctors.org.uk

Abstract

Swallowed button batteries (BB) which remain lodged in the oesophagus are at risk of serious complications, particularly in young children. The authors report a 3-year-old child, who rapidly developed an oesophageal perforation, following the ingestion of a 20-mm lithium BB which was initially mistaken for a coin. A thoracotomy and T-tube management of the perforation led to a positive outcome. BBs (20 mm) in children should be removed quickly and close observation is required as the damage initiated by the battery can lead to a significant injury within a few hours.

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Introduction

Button battery (BB) ingestion is a common complaint in toddlers. Increased use of lithium BB that are 20 mm in diameter has brought new challenges since they appear more dangerous than earlier types of batteries.1

Case report

A 3-year-old boy, with an ingested BB, whose radiographic appearance was presumed to be a coin lodged in the oesophagus, was transferred to our institution for further management after overnight observation (figure 1). A BB impacted in the distal oesophagus was retrieved by an oesophagoscopy 20 h after ingestion: moderate damage to the mucosa was noted. This eventually perforated and became clinically evident on the following day (figure 2). Management was right thoracotomy and latex rubber T-tube insertion into the perforation to create a controlled oesophago- pleura-cutaneous fistula for secondary intention healing.2 A mini-laparotomy allowed gastro- jejunal tube insertion. Two weeks postoperatively the child went home with the T-tube in situ. Three weeks later, the T-tube was removed by flexible oesophagoscopy, and the internal opening of the fistula was filled with Tissel.3 Three days later, a swallow contrast study showed a normal oesophagus with no leak and stricture. The child is on normal oral diet at 6 months follow-up.

Figure 1

The chest radiograph revealed the button battery (BB) as a circular radio-opaque shadow with a peripheral double rim (pathognomonic of BB).

Figure 2

One day after the button battery retrieval, the child developed respiratory distress. The chest radiograph revealed a large hydro-pneumothorax, a sign of oesophageal perforation.

Discussion

Signs of BB should be carefully checked on the antero-posterior (AP) (double-rim) and lateral (step off) x-ray.4 To prevent morbidity and mortality, in case of an unwitnessed ingestion, coin-like foreign bodies should be assumed BB until proven otherwise. T-tube insertion is a simple and effective method and avoids the postoperative complications associated with primary closure of severely inflamed oesophageal perforations.

References

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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