Button Battery Ingestion: A Conundrum of Preventable Sequelae Management (original) (raw)

2019, JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

A one-year-old child presented to the emergency outpatient department with reduced appetite, foul-smelling vomitus and alleged history of ingestion of a button battery from a television remote ten days before the hospital visit. ENT examination was normal. Radiography of the neck-anteroposterior view revealed a radio-opaque foreign body with double rim appearance in the cricopharynx with surrounding soft tissue oedema [Table/ Fig-1]. The child was immediately taken up for emergency rigid hypopharyngoscopy and foreign body removal under general anaesthesia within two hours of presentation to the hospital. Intraoperatively, a 20 mm, 3V Lithium button battery was identified at the level of the cricopharynx, 16 cm from the upper incisor, covered with slough [Table/Fig-2]. On removal of the foreign body, there was mucosal erosion with no evidence of perforation or bleeding. A nasogastric tube was inserted intra-operatively in view of the mucosal erosion. Immediate to post-operative period the child was kept nil per oral. Nasogastric tube aspirate showed brownish blood stained content, which turned clear in two days. The child was transferred to the Paediatric Intensive Care Unit for observation. On post-operative Day 3, the child developed an episode of seizure associated with minor bleeding from the nose and mouth. Blood investigations revealed hyponatremia and hypocalcaemia. The seizures were attributed to the same and were corrected, and the child showed clinical improvement without further episodes of seizures or bleeding. The child was asymptomatic and hence was started on oral feeds on post-operative Day 6. Child tolerated the oral feeds well. On post-operative Day 8, the child developed an episode of generalised tonic-clonic seizures associated with massive haematemesis, haematochezia and epistaxis leading to hypovolemic shock and cardiac arrest. Spontaneous circulation was achieved with cardiopulmonary resuscitation. However, the child continued to have persistent massive bleeding from the oral cavity, nose and rectum with abdominal distension. An Aorto-oesophageal fistula was suspected. Before intervention for the same, the child succumbed due to massive bleeding. Case 2 A one-year-old child presented with complaints of two episodes of bloodstained vomitus following ingestion of a button battery from a toy, nine hours before presenting to the hospital. ENT examination was normal. A radiograph of the neck-anteroposterior view revealed a circular radio-opaque foreign body with a double rim appearance, suggestive of a button battery at the level of C3-C4 [Table/Fig-3]. The child was immediately taken up for emergency rigid hypopharyngoscopy and foreign body removal