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Pefferkorn E, Clément B, Bascou A, Guilbeau-Frugier C, Telmon N, Savall F, Dedouit F. Death following cylindrical battery ingestion associated with toxic manganese levels. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00854-z. [PMID: 38951377 DOI: 10.1007/s12024-024-00854-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/03/2024]
Abstract
Cases of battery ingestion are well documented in the scientific literature, especially concerning button cell battery ingestion in children. In this instance, the authors present an atypical case of a young man who voluntarily ingested a cylindrical alkaline battery containing manganese. The patient died approximately a week later, despite not exhibiting any specific symptoms. The battery was found in the cecum during the autopsy, showing deterioration at its positive pole. The cecal mucosa exhibited two ulcerations without perforation. Histological analysis revealed intestinal ischemia in the cecum, with no microscopic lesions in other organs. Toxicology reports indicated high levels of manganese in both cardiac and peripheral blood. Considering all the results from the additional analyses, the experts concluded that the death was likely of multifactorial origin, associated with a toxic blood concentration of manganese. To the best of our knowledge, this is the first recorded death following the ingestion of a cylindrical battery, and the first instance of manganese intoxication resulting from the ingestion of an alkaline battery. The authors will present the case and provide a literature review to assess the extent to which the presence of manganese may have contributed to the fatality.
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Affiliation(s)
- Eulalie Pefferkorn
- Institute of Legal medicine, CHRU TOURS, Trousseau Hospital, Avenue de la république, Chambray-lès-Tours, 37170, France.
| | - Bruno Clément
- Department of Medical Pharmacology and toxicology, Bretonneau Hospital, 2 Boulevard Tonnellé, Tours, 37000, France
| | - Agathe Bascou
- Institute of Legal medicine, Rangueil-Larrey Hospital, 1 avenue du Professeur Jean-Poulhès, Toulouse, 31400, France
| | - Céline Guilbeau-Frugier
- Institute of Legal medicine, Rangueil-Larrey Hospital, 1 avenue du Professeur Jean-Poulhès, Toulouse, 31400, France
| | - Norbert Telmon
- Centre d'Anthropobiologie et de Génomique de Toulouse, UMR 5288 (CNRS/UT3) - Faculté de Médecine de Purpan - 37 allées J. Guesde, Toulouse, 31000, France
| | - Frédéric Savall
- Centre d'Anthropobiologie et de Génomique de Toulouse, UMR 5288 (CNRS/UT3) - Faculté de Médecine de Purpan - 37 allées J. Guesde, Toulouse, 31000, France
| | - Fabrice Dedouit
- Centre d'Anthropobiologie et de Génomique de Toulouse, UMR 5288 (CNRS/UT3) - Faculté de Médecine de Purpan - 37 allées J. Guesde, Toulouse, 31000, France
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Vaucel JA, Gil-Jardine C, Paradis C, Enaud R, Labadie M. Pre-hospital triage of children at risk of oesophageal button battery impaction: the button battery impaction score. Clin Toxicol (Phila) 2023; 61:1047-1054. [PMID: 38270057 DOI: 10.1080/15563650.2023.2289358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/26/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Button battery ingestion in children can be fatal if oesophageal perforation occurs. Such children require chest radiography in the emergency department to determine the button battery position and number. Current guidelines recommend that a button battery impacted in the oesophagus should be removed within two hours. We developed a clinical tool (the button battery impaction score) to estimate the risk of oesophageal impaction and help determine the most appropriate healthcare facility for initial assessment, either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval. METHODS A multi-centre retrospective study was conducted over seven years in eight French poison centres. We included patients aged less than 12 years with radiography showing the button battery position and a symptom description before radiography. Button battery impaction scores were calculated using backward stepwise selection. RESULTS AND DISCUSSION A total of 1,430 patients were included, of whom 86, 461, and 375 had a button battery in their oesophagus, stomach, and post-pyloric position, respectively. No button batteries were identified by radiography in 508 patients. Sixteen of thirty-five factors independently predicted oesophageal impaction before chest radiography (P < 0.05). After the backward stepwise selection, the following seven factors contributed to the button battery impaction score: cough, drooling, dysphagia/food refusal, fever, pain (unspecified location), vomiting, and button battery ≥ 15 mm. The button battery impaction score showed an area under the curve value of 0.87, a negative predictive value of 0.98, and a sensitivity of 0.86. No cases of death, stricture, or haemorrhage were observed in patients with negative scores, including those with oesophageal impaction. CONCLUSIONS A button battery impaction score used readily available data to predict the risk of oesophageal impaction after button battery ingestion and before chest radiography. When further validated, this rapid tool may be widely applicable in determining an appropriate facility for patient transfer to either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval.
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Affiliation(s)
- Jules-Antoine Vaucel
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
- Pole urgence SAMU SMUR, Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
| | - Cédric Gil-Jardine
- Pole urgence SAMU SMUR, Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
| | - Camille Paradis
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
| | - Raphael Enaud
- Pediatric Gastroenterology Department, Centre hospitalier et universitaire de Bordeaux, service de gastro-entérologie pédiatrique, Bordeaux, France
| | - Magali Labadie
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
- Pole urgence SAMU SMUR, Centre hospitalier et universitaire de Bordeaux, Bordeaux, France
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Labadie M, Vaucel JA, Courtois A, Nisse P, Legeay M, Medernach C, Patat AM, Von Fabeck K, Gallart JC, Tournoud C, Puskarczyk E. Button Battery Ingestion in Children (PilBouTox®): A Prospective Study Describing the Clinical Course and Identifying Factors Related to Esophageal Impaction or Severe Cases. Dysphagia 2023; 38:446-456. [PMID: 35841456 DOI: 10.1007/s00455-022-10485-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/13/2022] [Indexed: 01/27/2023]
Abstract
In this study, we aimed to identify the factors related to esophageal impaction following button battery (BB) ingestion in children. PilBouTox, a prospective multicentric observational cohort study, was conducted from French Poison Control Centers between June 1, 2016 and May 31, 2018. Children (0-12 years old) with BB ingestion were included. After ingestion, patients were monitored for 21 days or more if they remained symptomatic (maximum 1 year). Causes of ingestion, clinical manifestations, medical management, and the outcomes were recorded. In total, 415 patients were included; among them, 35 had esophageal impaction and 14 had severe complications or died. Seven symptoms were closely related (relative risk (RR) > 30) to esophageal impaction: anorexia, drooling, dyspnea, fever, hemodynamic instability, pallor, and pain. Furthermore, BBs > 15 mm were related to esophageal impaction (RR = 19, CI95% [4.1; 88]). The absence of initial symptoms was a protective factor for esophageal impaction (RR = 0.013, CI95% [0.002; 0.1]). Nine symptoms were closely related (RR > 30) to major effects and death: dyspnea, cough, dysphagia, drooling, fever, hemodynamic instability, pain, pallor, and vomiting. Seven symptoms were related to esophageal impaction and their rapid recognition could help to ensure that the patient is taken to a health care facility. Nine factors were related to the major effects of BB ingestion. We recommended an X-ray as soon as possible to determine the position of the BB.Trial Registry: Clinical Trial ID: NCT03708250, https://clinicaltrials.gov/ct2/show/NCT03708250.
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Affiliation(s)
- Magali Labadie
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France.
| | - Jules-Antoine Vaucel
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France
| | - Arnaud Courtois
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France
| | - Patrick Nisse
- Centre Antipoison [Lille Poison Control Center], Centre Hospitalier et Universitaire de Lille, 59000, Lille, France
| | - Marion Legeay
- Centre Antipoison [Angers Poison Control Center], Centre Hospitalier et Universitaire de Angers, 49000, Angers, Pays de la Loire, France
| | - Chantal Medernach
- Centre Antipoison de Paris [Paris Poison Control Center]-Fédération de Toxicologie, Groupe Hospitalier Lariboisière Fernand-Widal, 75000, Paris, Île-de-France, France
| | - Anne-Marie Patat
- Centre Antipoison [Lyon Poison Control Center], Centre Hospitalier et Universitaire de Lyon, 69000, Lyon, Auvergne-Rhône-Alpes, France
| | - Katharina Von Fabeck
- Centre Antipoison [Marseille Poison Control Center], Centre Hospitalier et Universitaire de Marseille, 13000, Marseille, France
| | - Jean-Christophe Gallart
- Centre Antipoison-SAMU 31 [Toulouse Poison Control Center], Centre Hospitalier et Universitaire de Toulouse, 31000, Toulouse, Midi-Pyrénées, France
| | | | - Christine Tournoud
- Centre Antipoison [East Poison Control Center], Centre Hospitalier et Universitaire de Nancy, 54000, Nancy, Lorraine, France
| | - Emmanuel Puskarczyk
- Centre Antipoison [East Poison Control Center], Centre Hospitalier et Universitaire de Nancy, 54000, Nancy, Lorraine, France
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