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Case Reports
. 2018 Oct 18;12(1):318.
doi: 10.1186/s13256-018-1818-5.

Button battery removed from the stomach resulting in a missed aortoesophageal fistula - a multidisciplinary approach to rescuing a very young patient: a case report

Antonino Granata  1 , Caterina Gandolfo  2 , Carlo Acierno  3 , Marcello Piazza  4 , Gaetano Burgio  4 , Mario Traina  5
Affiliations
Case Reports

Button battery removed from the stomach resulting in a missed aortoesophageal fistula - a multidisciplinary approach to rescuing a very young patient: a case report

Antonino Granata et al. J Med Case Rep. .

Abstract

Background: While coins are still the most common foreign bodies swallowed by children, ingestion of batteries has become more frequent among children due to the increasing access to electronic toys and devices. Coin battery ingestion is potentially life threatening for children. Aortoesophageal fistula is the most common cause of death in children who have swallowed coin batteries, and there have not been any reported survivors.

Case presentation: A 3-year-old Caucasian girl presented to the emergency room of a community hospital complaining of abdominal pain. An abdominal X-ray showed a coin lithium battery located in the fundus of her stomach, and she was transferred to a referral pediatric hospital. In the following hours she developed massive hematemesis and severe hypovolemic shock. An emergency laparotomy was attempted, and the coin battery was removed. The initial surgery and multiple blood transfusions did not, however, improve the clinical situation. She was then referred to our tertiary referral center, where a multidisciplinary team decided to attempt a combined angiographic and endoscopic approach to resolve a life-threatening aortoesophageal fistula. A 3-year follow-up was uneventful.

Conclusions: Coin batteries are designed for a wide variety of small appliances, such as hearing aids, watches, remote controls, and toys. Although a change in the clinical approach to battery ingestion is needed to avoid misdiagnosis or delayed treatment, primary prevention of battery ingestion would be even more effective than an improved treatment.

Keywords: Aortic rupture; Balloon-expandable stents; Bleeding; Hemostasis; Thoracic endovascular aortic repair; Urgent procedure.

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Conflict of interest statement

Ethics approval and consent to participate

Authors are reporting for the first time, a successful emergency combined angiographic and endoscopic approach to resolving a life-threatening aortoesophageal fistula after ingestion of a lithium-cell coin-battery. The procedure was performed as rescue therapy in an emergency medical condition.

Consent for publication

Written informed consent was obtained from the patient’s legal guardians for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
X-ray showing a coin lithium battery (CR 2025) located in the fundus of the stomach
Fig. 2
Fig. 2
a Aortoesophageal fistula (endoscopic view); b flat scars on the previous bleeding site (1-year endoscopic follow-up)
Fig. 3
Fig. 3
Extravasation of contrast from aorta to the esophagus as shown by the arrowhead (X-ray view)
Fig. 4
Fig. 4
Released aortic covered balloon-expandable stainless steel stent (X-ray view)
See this image and copyright information in PMC

References

    1. Gregori D, Scarinzi C, Morra B, Salerni L, Berchialla P, Snidero S, et al. Ingested foreign bodies causing complications and requiring hospitalization in European children: results from the ESFBI study. Pediatr Int. 2010;52(1):26–32. doi: 10.1111/j.1442-200X.2009.02862.x. - DOI - PubMed
    1. Hamilton JM, Schraff SA, Notrica DM. Severe injuries from coin cell battery ingestions: 2 case reports. J Pediatr Surg. 2009;44(3):644–647. doi: 10.1016/j.jpedsurg.2008.10.110. - DOI - PubMed
    1. Samad L, Ali M, Ramzi H. Button battery ingestion: hazards of esophageal impaction. J Pediatr Surg. 1999;34(10):1527–1531. doi: 10.1016/S0022-3468(99)90119-7. - DOI - PubMed
    1. Mortensen A, Hansen NF, Schiødt OM. Fatal aortoesophageal fistula caused by button battery ingestion in a 1-year-old child. Am J Emerg Med. 2010;28(8):984. doi: 10.1016/j.ajem.2010.01.007. - DOI - PubMed
    1. Jiraki K. Aortoesophageal conduit due to a foreign body. Am J Forensic Med Pathol. 1996;17(4):347–348. doi: 10.1097/00000433-199612000-00014. - DOI - PubMed

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