Delayed presentation of button battery ingestion: a devastating complication

Abstract

A 12-month-old child presented with a prolonged history of fever, cough and difficulty breathing, which was initially treated as bronchiolitis. She was discharged but presented again to Accident and Emergency department 4 days later with worsening symptom. Following deterioration in the Emergency department, a chest X-ray revealed a button battery in the upper oesophagus. Emergency oesophagoscopy was performed where a 20 mm button battery was removed and a tracheoesophageal fistula was seen 12 mm above the carina. Near total oesophagectomy, cervical oesophagostomy and gastrostomy were performed with a patch repair of the trachea, followed by a bioabsorbable tracheal stent. The patient spent a prolonged period of time in intensive care and was treated with intravenous antibiotics for mediastinitis. This case highlights the difficulty in diagnosis of button batteries when there is no clear history and the devastating consequences of prolonged exposure.

Keywords: Gastroenterology; Oesophagus; Otolaryngology.

Figure 1

AP erect chest X-ray.

Figure 2

Lateral soft tissue neck X-ray.