Pathophysiology of esophageal impairment due to button battery ingestion (original) (raw)
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The Laryngoscope, 2016
Objectives/Hypothesis: Button battery (BB) injuries continue to be a significant source of morbidity and mortality, and there is a need to confirm the mechanism of injury for development of additional mitigation strategies. Study Design: Cadaveric piglet esophageal model. Methods: Lithium, silver oxide, alkaline, and zinc-air BBs were placed in thawed sections of cadaveric piglet esophagus, bathed in normal saline. Severity of gross visual burn, pH, and temperature were recorded every 30 minutes for 6 hours. In other esophageal tissue specimens, the lithium BB was removed after 24, 36, and 48 hours and the site was irrigated with either 0.25% or 3% acetic acid. Separately, ReaLemon V R juice, orange juice, Coke V R , Dasani V R water, Pepsi V R , and saline were infused over a vertically suspended esophagus with a CR2032 lithium battery every 5 minutes for 2 hours while tissue temperature and pH were measured. Results: A gradual rise in tissue pH and minimal change in temperature was noted for all BBs. ReaLemon V R and orange juice applied every 5 minutes were most effective at neutralization of tissue pH with minimal change in tissue temperature. After BB removal (24, 36, 48 hours), irrigation of esophageal tissue specimens with 50-150 mL 0.25% acetic acid neutralized the highly alkaline tissue pH. Conclusions: BB appear to cause an isothermic hydrolysis reaction resulting in an alkaline caustic injury. Potential new mitigation strategies include application of neutralizing weakly acidic solutions that may reduce esophageal injury progression.
Severe esophageal damage due to button battery ingestion: can it be prevented?
Pediatric Surgery International, 2004
Batteries represent less than 2% of foreign bodies ingested by children, but in the last 2 decades, the frequency has continuously increased. Most ingestions have an uneventful course, but those that lodge in the esophagus can lead to serious complications and even death. Medline was used to search the English medical literature, combining ''button battery'' and ''esophageal burn'' as keywords. Cases were studied for type, size, and source of the batteries; duration and location of the battery impaction in the esophagus; symptoms; damage caused by the battery; and outcome. Nineteen cases of esophageal damage have been reported since 1979.Batteries less than 15 mm in diameter almost never lodged in the esophagus. Only 3% of button batteries were larger than 20 mm but were responsible for the severe esophageal injuries in this series. These data suggest that manufacturers should replace large batteries with smaller ones and thus eliminate most of the complications. When the battery remains in the esophagus, endoscopic examination and removal done urgently will allow assessment of the esophageal damage, and treatment can be tailored accordingly. There is a need for more public education about the dangers of battery ingestion; this information should be included as part of the routine guidelines for childproofing the home.
Battery-induced Esophageal Foreign Body Injury, Complications and Treatment Outcome
West Indian Medical Journal, 2016
Objective: We aimed to assess the severity caused by button batteries in esophagus. Methods: Thirty two patients admitted with ingesting button batteries were retrospectively evaluated. Chest x-ray was ordered for diagnosis. Hospital stays, interventions , complications and mortality of the patients were collected. The time between the patients ingested the buton battery and its removal was defined as its duration in esophagus. All the patients underwent rigid esophagoscopy under general anasthesia. Buton batteries at the first narrowing were removed by magyl clamp. Results: 21 of 32 patients were female, with a mean age of 22 months. The mean duration of ingestion was 17 hours. The mean hospital stay was 10 days. Of the patients, 75% were admitted within 24 hours. Complication rate was 19% and mortality rate was 6%. There was a strong correlation among the number of the cases and the coming years (p<0.001). Linear regression test was used in the number of cases and the duration ...
Button battery ingestion- case report and review
IP international journal of forensic medicine and toxicological sciences, 2020
Over the last few years there is a rise in use of button batteries in various toys and other electronic gadgets. Easy availability and small size of these batteries pose a significant risk of ingestion in small children. Button battery ingestion can lead to serious health hazards very rapidly. A 2-year-old girl presented to the emergency room of a community hospital complaining of hematemesis. X-ray showed a coin lithium battery located in the esophagus, and she was transferred to a referral hospital and succumbed to death after 4 hours survival in king george hospital. Postmortem examination revealed massive blood clots in stomach.
Button Battery Ingestion: A Conundrum of Preventable Sequelae Management
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2019
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
Button battery induced cell damage: A pathophysiological study
Electrochemistry Communications, 2008
Button batteries (BB) are frequently swallowed and must be removed immediately as, if they remain in the esophagus, they can cause severe damage with fatal prognosis. To better understand the molecular mechanism of esophagus damage, we performed a study aimed to analyze heat production, pH variation, electrical work and metal release from BB incubated in cell culture media. Cytotoxicity and apoptosis induced in a human monocytes cell line (U937) was also investigated.
Button battery ingestion in children: An emerging hazard
Journal of Digestive Endoscopy, 2013
Button battery ingestion is an emerging hazard. In this retrospective study, we report six cases of lithium button battery ingestion in pediatric age group (mean age 2.8 years). Three button batteries were removed from stomach and three from esophagus. Esophageal site was associated with significant local injury, and one button battery was impacted in the esophagus, requiring rigid esophagoscopy for removal. Small battery size, used batteries, and early removal (<12 h after ingestion) were associated with lesser mucosal injury. No long-term complications were noted. Our study emphasizes that early diagnosis and urgent removal of ingested button battery are the only measures which prevent complications.