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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 110-111

Corrosive esophageal injury caused by impacted button battery


Department of Anaesthesiology & Critical Care, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Sri Balaji Vidyapeeth (Deemed University), Puducherry, India

Date of Submission26-Oct-2019
Date of Acceptance12-Apr-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Dr. Charulatha Ravindran
MD, Assistant Professor, Department of Anaesthesiology & Critical Care, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Sri Balaji Vidyapeeth (Deemed University), Puducherry 607403
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacp.jacp_41_19

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How to cite this article:
Ravindran C, R. S, Jayaraman G. Corrosive esophageal injury caused by impacted button battery. J Assoc Chest Physicians 2020;8:110-1

How to cite this URL:
Ravindran C, R. S, Jayaraman G. Corrosive esophageal injury caused by impacted button battery. J Assoc Chest Physicians [serial online] 2020 [cited 2020 Oct 30];8:110-1. Available from: https://www.jacpjournal.org/text.asp?2020/8/2/110/294591



Button batteries larger than 20 mm when ingested by toddlers get impacted in the narrow esophagus causing significant injury to the upper aerodigestive tract.[1] The button battery in the above image was recovered from a two year old child, who had presented with drooling of saliva and refusal of feeds for the past two days. [Figure 1]A shows the button battery with negative pole facing anteriorly and a retropharyngeal abscess secondary to the foreign body. Impaction of the battery more than 48 hours had caused deep erosive ulcerations in the esophageal mucosa [Figure 1]B due to electrolysis and alkaline caustic injury. 1 Though the battery was identified in the upper esophagus [Figure 1]A, induction of anaesthesia had caused the battery to migrate into the stomach. The battery was recovered from the stomach and during its short transit time, had caused superficial ulcers in lower esophagus. The battery was removed by endoscopy under general anaesthesia and the postoperative period was uneventful. Barium swallow did not reveal any fistula due to the corrosive injury.
Figure 1 A X ray of the child in lateral view showing the button battery and retropharyngeal abscess, B endoscopy image of the upper esophagus showing deep corrosive injuries due to impacted button battery. Inset image – Button battery after removal.

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Diagnosis of button battery ingestion in less than five years old children is an emergency and activation of an emergency protocol similar to trauma management is required.[2] Children are usually not in the fasting state and rapid sequence induction is necessary. Care should be taken to prevent obstruction or displacement of endotracheal tube by the endoscope. Nasogastric tube insertion should be avoided to prevent injury to the friable mucosa. Recent guidelines recommend irrigation with dilute acids to counteract the caustic injury.[2] Children may require anaesthesia for repeat endoscopy or pertinent imaging to identify complications like fistulae or vascular erosions.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Eliason MJ, Ricca RL, Gallagher TQ. Button battery ingestion in children. Curr Opin Otolaryngol Head Neck Surg 2017;25:520-6.  Back to cited text no. 1
    
2.
Ing RJ, Hoagland M, Mayes L, Twite M. The anesthetic management of button battery ingestion in children. Can J Anesth 2018;65:309-18.  Back to cited text no. 2
    
3.
Varga Á, Kovács T, Saxena A. Analysis of complications after button battery ingestion in children. Pediatr Emerg Care 2018;34:443-6.  Back to cited text no. 3
    


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