Button battery foreign bodies in children: hazards, management, and recommendations

Successful management of a delayed presented button battery ingestion in a toddler: A case report and literature review

Key Clinical Message

It is important to note that prevention of button battery ingestion is the most effective way to reduce its incidence and complications. This is unachievable without providing educational plans for parents. Moreover, triage nurses and first-line staff who take the history of patients and physicians should take the history to evaluate the risk of battery ingestion. Plain radiographs can be helpful in this matter, as the presence of "Hallow" and "Steep" signs in the anteroposterior and lateral views, respectively, can help.

Abstract

Foreign body ingestion is a relatively common occurrence in pediatrics, especially among children 1-3 years of age. Although most cases are benign and managed conservatively, those with high-risk subjects such as button batterie can bring about fatal conditions in the minority of cases. In the present study, the history, diagnostic, and therapeutic procedures of a 13-month-old baby with the final diagnosis of button battery ingestion are presented. The parents ignored the symptoms, suspecting that it was a viral infection. The evaluations showed that a battery was lodged in the middle part of the thoracic esophagus, which was removed by an urgent endoscopic procedure. The patient was under observation and on a nothing-by-mouth diet for a week, receiving nutritional fluid with a nasogastric tube. The necrosis, which was obvious after the removal of the battery, was healing in the second control esophagogastroduodenoscopy performed 1 week after the procedure. The stricture was minimal, and no need for dilation was diagnosed. This case report underscores the importance of a timely diagnosis and removal of these cases. This case underscores the importance of the timely presentation of these cases to health care and the risk of delayed removal, such as necrosis, forming fistula, and perforation of the esophagus. The delay can cause necrosis, fistula, and perforation and might lead to irreversible severe complications and even death.

Management of Foreign Bodies in the Ear Canal

Using the appropriate instruments and techniques for removing a foreign body from the external auditory canal facilitates the procedure and reduces the risk of complications. Most ear foreign bodies can be addressed on a nonurgent basis, but batteries and caustic materials warrant prompt removal. Referral to an otolaryngologist should be considered for difficult cases or after a failed attempt.

Management of pediatric aural foreign bodies: Towards a universal Otolaryngology referral algorithm

OBJECTIVES

Children with aural foreign bodies (AFB) frequently present to the Emergency Department (ED). Our objective was to analyze patterns of pediatric AFB management at our center to characterize children who are commonly referred to Otolaryngology.

METHODS

A retrospective chart review of all children (ages 0-18 years) presenting with AFB to the tertiary care Pediatric ED over a three-year period was performed. Demographics, symptoms, type of AFB, retrieval strategy, complications, need for Otolaryngology referral, and, use of sedation, were evaluated with respect to outcomes. Univariable logistic regression models were conducted to determine which patient characteristics were predictive of AFB removal success.

RESULTS

One hundred and fifty-nine patients seen at the Pediatric ED met the inclusion criteria. Average age at presentation was 6 years (2-18 years). Otalgia was the most common presenting symptom (18.0%). However, only 27.0% of children were symptomatic. ED physicians primarily flushed AFBs out of the external auditory canal with water, whereas Otolaryngologists exclusively used direct visualization. Otolaryngology-Head & Neck Surgery (OHNS) was consulted for 29.6% of children. Of these, 68.1% had complications associated with prior retrieval attempts. Sedation was administered in 40.4% of referred children, with 21.2% in an operative setting. Patients experiencing multiple retrieval methods by ED, and, age less than 3 years, were more likely to be referred to OHNS.

CONCLUSION

Patient's age should be strongly considered as a factor for early OHNS referral. By synthesizing our conclusions with previously published results, we propose a referral algorithm.

Analysis of Nasal Foreign Bodies in South Korea: Over 10-Year Experience

Foreign bodies (FBs) in the nasal cavity are commonly encountered in otorhinolaryngology. This retrospective study was conducted between January 2009 and December 2020. The nasal FB frequencies were investigated according to age and sex. The type, shape, and location of the FBs, onset, and clinical features were obtained. In a total of 1228 cases, the average age was 3.9 ± 5.7 years. We found a higher incidence in patients 2–4 years old. The most frequent nasal FBs were beads (24.0%), toys/plastics (17.8%), and beans/corn (15.8%). However, there were some differences in the nasal FB types according to the age group. There was no difference in the location of the nasal FBs according to age group, but nasal FBs were found more frequently in the right nasal cavity in the 1–3-years-old groups. Most patients (97.5%) visited the hospital the same day when the nasal FB insertion was suspected, and most were asymptomatic. After the removal of the nasal FBs, most patients were free of complications. Of the nine cases involving button batteries, septal perforation was observed in two patients who visited the hospital one or two days after the FB insertion. There were specific age-based characteristics of the nasal FBs that may serve as a basis for specific precautions.

Airway Complications Resulting From Pediatric Esophageal Button Battery Impaction: A Systematic Review

Importance

Button batteries (BBs) are commonly found in many household items and present a risk of severe injury to children if ingested. The direct apposition of the trachea and recurrent laryngeal nerves with the esophagus puts children at risk of airway injury secondary to the liquefactive necrotic effects of BB impactions.

Objective

To review airway injuries, including long-term sequelae, after BB ingestion in children.

Evidence Review

For this systematic review, a comprehensive strategy was designed to search MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL (Cumulative Index of Nursing and Allied Health Literature) from inception to July 31, 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Additional cases were identified from the National Capital Poison Center BB registry. Individual authors were contacted for additional information. Studies with pediatric patients (<18 years) who developed airway injuries after BB ingestion were included. A total of 195 patients were included in the analysis; 95 were male. The mean (SD) age at BB ingestion was 17.8 (10.2) months. The mean (SD) time from BB ingestion to removal was 5.8 (9.0) days. The 2 most common airway sequelae observed in our series were 155 tracheoesophageal fistulae and 16 unilateral vocal cord paralyses. Twenty-three children had bilateral vocal cord paralysis. The mean (SD) duration of ingestion leading to vocal cord paralysis was shorter than that of the general cohort (17.8 [22.5] hours vs 138.7 [216.7] hours, respectively). Children presenting with airway symptoms were likely to have a subsequent tracheoesophageal fistula or vocal cord paralysis.

Conclusions and Relevance

Airway injuries are a severe consequence of BB ingestion, occurring more often in younger children. This systematic review found that tracheoesophageal fistulae and vocal cord paralyses were the 2 most common airway injuries, often requiring tracheostomy. Vocal cord injury occurred after a shorter BB exposure time than other airway injuries. Continued efforts should be directed toward prevention strategies to avoid the devastating sequelae of BB-associated airway injury.

Management of oesophageal impaction of button batteries in Queensland

BACKGROUND

Oesophageal button battery impaction (OBBI) is a medical emergency requiring timely removal due to rapid oesophageal tissue injury. The aim of this study was to characterize circumstances of OBBI and identify potential barriers to timely removal of button batteries (BB) in the paediatric population.

METHODS

This is a retrospective review of OBBI cases between January 2018 to June 2019. Medical records were used to obtain patient demographics, battery size and type, battery source, location of initial presentation and outcomes. Time to obtaining x-ray, transfer to tertiary centre and to removal of button battery were recorded.

RESULTS

Eight cases of OBBI were recorded during the 18 months study timeframe. Six patients were male and two were female, aged 0.97 to 2.8 years. Six were from an English-speaking background and two were from families of non-English speaking background. Battery removal occurred at Queensland Children's Hospital (QCH) in seven of eight cases. Time from ingestion to initial presentation to hospital ranged from 39 min to 123 h with a mean time of 2 h and 13 min. Overall, the total time from ingestion of BB to removal ranged from 2 h 54 min to 126 h 51 min.

CONCLUSION

Despite being recognized as a time critical emergency, diagnostic, geographic and logistic challenges in Queensland make optimal care a challenge. Primary prevention strategies coupled with an expanded network for safe battery removal, and novel management strategies such as honey and acetic acid could improve care and reduce morbidity.

Battery Ingestion with Colonic Perforation after Colostomy Closure in a Toddler

Disc and button battery ingestion in children is common. In fact, data reports a dramatic increase in battery ingestion during the coronavirus disease 2019 pandemic likely as a result of increased household population density and electronic product utilization. These batteries often remain lodged in the esophagus causing potentially devastating complications if they are not removed urgently. Batteries that are passed beyond the esophagus usually do not cause any complications. We present the case of a 15-month-old male who underwent a colostomy takedown 2 months following a posterior sagittal anorectoplasty for imperforate anus. He recovered quickly, was advanced on his diet, and was discharged to home on postoperative day 3. On postoperative day 5 following the stoma closure, he presented with an acute abdomen, pneumoperitoneum and an abdominal X-ray that revealed a 21 mm disc battery in the left lower quadrant. He underwent exploration and the battery was found perforating the anastomosis. There was significant fibropurulent exudate and inflammation. The battery was removed, the anastomosis was excised, and a colostomy with Hartman's pouch was performed. The toddler recovered uneventfully. This case offers an opportunity to discuss the concerns of battery ingestion and postoperative care following intestinal surgery in children. We could find no other similar reports in the world's literature of a disrupted colonic anastomosis due to battery ingestion.

Surgical repair of massive hemorrhage secondary to button battery ingestion causing aortoesophageal fistula

BACKGROUND

In pediatrics, foreign body ingestion poses unique challenges. Each case is unique given variability in timing, type, and size of object, compounded by underlying comorbidities and age. In the mid-1990s, mortality and morbidity associated with button battery (BB) ingestion (BBI) emerged corresponding to modification in battery fabrication towards higher voltage, large-diameter lithium cells.

AIMS

To describe the case and management of a BBI in a pediatric patient necessitating the use of cardiopulmonary bypass and deep hypothermic circulatory arrest (DHCA).

MATERIALS AND METHODS

A 17-month-old female presented with the sudden loss of consciousness at home. Chest X-ray revealed an esophageal foreign body suspicious for BBI. A massive upper gastrointestinal bleeding was temporized with packing. The patient was urgently taken to the operating room for sternotomy, establishment of cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA), removal of BB, repair of the left common carotid artery, esophageal, and tracheal injuries.

DISCUSSION

Successful management of BBI requires coordinated care and a multidisciplinary approach. A high degree of clinical suspicion for BBI is imperative to facilitate early aggressive interventions. Lateral and anteroposterior chest films should be obtained in any suspected BBI.

CONCLUSION

This case demonstrates the utility of CPB and DHCA where control of bleeding secondary to BBI is not otherwise possible.

Endoscopic Evaluation for Stricture Formation Post Button Battery Ingestion

Every year, there are over 3300 ingestions of button batteries, mostly by young children. Initial presentation of button battery ingestion may be nonspecific, with a delay in diagnosis and removal resulting in increased risk of complications. We present the case of a five-year-old female who presented with vomiting following unwitnessed button battery ingestion. The battery was impacted in the middle esophagus for at least six hours. Endoscopy was performed for immediate removal and showed a Grade 2B erosion, warranting nasogastric tube placement. The patient remained asymptomatic following discharge and had a barium swallow that was read as normal. However, a repeat endoscopy one month later visualized stricture formation at the previous battery injury site. This case highlights the importance of both clinician and parent awareness of button battery ingestion and demonstrates that endoscopy provides the most accurate assessment of esophageal injury and complication development, even in asymptomatic patients.

Presentation and management of nasal foreign bodies in a Chinese metro area

Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children's Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area.

Esophageal Button Battery in the Pediatric Population: Experience from a Tertiary Care Center

OBJECTIVES

To highlight different patterns of clinical presentation, share authors' experience in the management of children following button battery ingestion and their outcomes.

METHODS

This is a single center descriptive cohort study with a total duration of 5 y (January 2014 through December 2018). Battery removal was performed by urgent rigid esophagoscopy following department protocols. Outcomes and complications were observed in the post-operative period in all children. Contrast esophagogram was performed at 4-6 wk post battery removal for assessing esophageal emptying and detecting sequelae (stricture).

RESULTS

Fifty-two children (M:F = 31:21) with a mean age (+SD) at presentation of 47 (+27) mo were managed at authors' center during the study period. Most common source of button battery was electronic appliance remote (50%) and common symptoms at presentation were vomiting after feeds, dysphagia, chest pain etc. During endoscopic retrieval, majority (60%) of the batteries were lodged in the upper esophagus and predominant impaction was noticed at anterior wall (81%) of esophagus. Upon injury assessment, grade 3 followed by grade 2 were detected in 59% and 41% cases respectively. Five children developed complications. Two deaths due to catastrophic hemorrhage (aorto-esophageal fistula) and refractory sepsis (tracheoesophageal fistula) occurred in present cohort. While contrast esophagogram was normal in all survivors, self-limiting symptoms like mild chest pain during swallowing and cough were observed during the follow-up. Median (IQR) duration of hospital stay and follow-up were 2 d (1-2.75) and 14.5 mo (8.5-17.5) respectively.

CONCLUSIONS

Accidental button battery ingestion can be life-threatening. Diagnosis is often delayed due to non-specific clinical presentation and unwitnessed ingestions. Esophagoscopic retrieval is the treatment modality of choice. Despite having significant esophageal injury at the time of removal, no long-term sequelae (clinical or radiological) were observed in present study.

Clinical Practice Guideline: Nosebleed (Epistaxis)

OBJECTIVE

Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient's quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds.

PURPOSE

The primary purpose of this multidisciplinary guideline is to identify quality improvement opportunities in the management of nosebleeds and to create clear and actionable recommendations to implement these opportunities in clinical practice. Specific goals of this guideline are to promote best practices, reduce unjustified variations in care of patients with nosebleeds, improve health outcomes, and minimize the potential harms of nosebleeds or interventions to treat nosebleeds. The target patient for the guideline is any individual aged ≥3 years with a nosebleed or history of nosebleed who needs medical treatment or seeks medical advice. The target audience of this guideline is clinicians who evaluate and treat patients with nosebleed. This includes primary care providers such as family medicine physicians, internists, pediatricians, physician assistants, and nurse practitioners. It also includes specialists such as emergency medicine providers, otolaryngologists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, the emergency department, the inpatient hospital, and even remote outpatient encounters with phone calls and telemedicine. Outcomes to be considered for patients with nosebleed include control of acute bleeding, prevention of recurrent episodes of nasal bleeding, complications of treatment modalities, and accuracy of diagnostic measures. This guideline addresses the diagnosis, treatment, and prevention of nosebleed. It focuses on nosebleeds that commonly present to clinicians via phone calls, office visits, and emergency room encounters. This guideline discusses first-line treatments such as nasal compression, application of vasoconstrictors, nasal packing, and nasal cautery. It also addresses more complex epistaxis management, which includes the use of endoscopic arterial ligation and interventional radiology procedures. Management options for 2 special groups of patients-patients with hereditary hemorrhagic telangiectasia syndrome and patients taking medications that inhibit coagulation and/or platelet function-are included in this guideline. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not intended to be a comprehensive, general guide for managing patients with nosebleed. In this context, the purpose is to define useful actions for clinicians, generalists, and specialists from a variety of disciplines to improve quality of care. Conversely, the statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients.

ACTION STATEMENTS

The guideline development group made recommendations for the following key action statements: (1) At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not. (2) The clinician should treat active bleeding for patients in need of prompt management with firm sustained compression to the lower third of the nose, with or without the assistance of the patient or caregiver, for 5 minutes or longer. (3a) For patients in whom bleeding precludes identification of a bleeding site despite nasal compression, the clinician should treat ongoing active bleeding with nasal packing. (3b) The clinician should use resorbable packing for patients with a suspected bleeding disorder or for patients who are using anticoagulation or antiplatelet medications. (4) The clinician should educate the patient who undergoes nasal packing about the type of packing placed, timing of and plan for removal of packing (if not resorbable), postprocedure care, and any signs or symptoms that would warrant prompt reassessment. (5) The clinician should document factors that increase the frequency or severity of bleeding for any patient with a nosebleed, including personal or family history of bleeding disorders, use of anticoagulant or antiplatelet medications, or intranasal drug use. (6) The clinician should perform anterior rhinoscopy to identify a source of bleeding after removal of any blood clot (if present) for patients with nosebleeds. (7a) The clinician should perform, or should refer to a clinician who can perform, nasal endoscopy to identify the site of bleeding and guide further management in patients with recurrent nasal bleeding, despite prior treatment with packing or cautery, or with recurrent unilateral nasal bleeding. (8) The clinician should treat patients with an identified site of bleeding with an appropriate intervention, which may include one or more of the following: topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents. (9) When nasal cautery is chosen for treatment, the clinician should anesthetize the bleeding site and restrict application of cautery only to the active or suspected site(s) of bleeding. (10) The clinician should evaluate, or refer to a clinician who can evaluate, candidacy for surgical arterial ligation or endovascular embolization for patients with persistent or recurrent bleeding not controlled by packing or nasal cauterization. (11) In the absence of life-threatening bleeding, the clinician should initiate first-line treatments prior to transfusion, reversal of anticoagulation, or withdrawal of anticoagulation/antiplatelet medications for patients using these medications. (12) The clinician should assess, or refer to a specialist who can assess, the presence of nasal telangiectasias and/or oral mucosal telangiectasias in patients who have a history of recurrent bilateral nosebleeds or a family history of recurrent nosebleeds to diagnose hereditary hemorrhagic telangiectasia syndrome. (13) The clinician should educate patients with nosebleeds and their caregivers about preventive measures for nosebleeds, home treatment for nosebleeds, and indications to seek additional medical care. (14) The clinician or designee should document the outcome of intervention within 30 days or document transition of care in patients who had a nosebleed treated with nonresorbable packing, surgery, or arterial ligation/embolization. The policy level for the following recommendation, about examination of the nasal cavity and nasopharynx using nasal endoscopy, was an option: (7b) The clinician may perform, or may refer to a clinician who can perform, nasal endoscopy to examine the nasal cavity and nasopharynx in patients with epistaxis that is difficult to control or when there is concern for unrecognized pathology contributing to epistaxis.

Clinical Profile and Outcome of Esophageal Button Battery Ingestion in Children: An 8-Year Retrospective Case Series

Objective

To present the clinical profile and outcomes of esophageal button battery ingestion cases treated at our institution over an 8-year period.

Methods

A total of 17 children who presented after ingesting a button battery and were treated at a tertiary care clinic over an 8-year period were included in this retrospective case series study. Data on patient demographics and esophageal location of the battery, time from ingestion to admission, symptoms, grade of mucosal injury, size of the battery, management, complications, and follow-up outcome were recorded.

Results

Median age was 29 months (range, 2–99 months). Boys comprised (n=11, 64.7%) of the study population. The most common location was the proximal esophagus (n=10, 58.8%). The median time from ingestion to admission was 6 h (range, 3–24 h). Hypersalivation alone (n=6, 35.3%) or together with vomiting (n=5, 29.4%) was the most common symptom. Grade IIA mucosal injury was noted in six (n=6, 35.3%) patients. The diameter of the battery was a median of 18.0 mm (range, 14–22 mm). We did not observe any correlation between the size of the battery and the grade of the injury. Early postoperative complications were encountered in one patient (n=1, 5.8%) and late postoperative complications were noted in eight patients (n=8, 47.1%) which required further esophageal dilatations, and follow-up revealed normal findings in eight patients (n=8, 47.1%) and mortality occurred in one patient.

Conclusion

The current case series study describing the clinical profiles and outcomes of 17 children who had ingested an esophageal button battery revealed male predominance, young patient age, and admission after a median of 6 h (3–24 h) of ingestion with nonspecific symptoms. Our findings confirm the success of rigid endoscopy to remove esophageal button batteries and indicate the likelihood of severe complications after removal.

Analysis of nasal foreign bodies in 341 children

OBJECTIVE

This study aimed to analyse the common presentations and treatment outcomes in cases involving nasal foreign bodies.

METHODS

A retrospective study was carried out over three years, from January 2014 to December 2017. Patient biodata, clinical presentation, nasal foreign body type and management outcome data were obtained from the medical records and analysed.

RESULTS

A total of 341 cases were analysed. The average patient age was 3.7 ± 1.2 years (range, 1-19 years).Of the nine cases involving button batteries, septal perforation was initially seen in four cases and three cases had subsequent septal perforation.

CONCLUSION

Only button battery nasal foreign bodies were associated with increased septal perforation. Use of physiological seawater nasal spray was found to reduce the likelihood of septal perforation. Most nasal foreign bodies could be removed under local anaesthesia.

The novel use of a nasal bridle system to remove a foreign body in the ear

Foreign bodies in the ear are a common presentation that prompt referral to Otolaryngology. We describe a technique that is safe and simple to perform for the removal of metallic foreign bodies in the ear. Case report of an elderly gentleman presenting with otalgia and a hearing aid battery lodged within bony external ear canal.

Predictors of nature of ingested foreign bodies in children & assessment of operative outcomes

OBJECTIVE

To examine sensitivity/specificity of history & radiology to identify ingested foreign body (FB) and develop a protocol for management of ingested FBs in paediatric patients; to assess outcomes of removal of lithium button battery foreign body (LBBFB).

METHODS

Retrospective review. Children presenting to ENT emergency with suspected FB ingestion underwent rigid esophagoscopy and FB removal. Average age, number of attempts, duration of ingestion, success rate, and complications were analysed.

RESULTS

Cases of coin/LBBFB ingestion: 916/70. Mean age: 5.8/2.03 years (p < 0.001). Average duration of ingestion: 37/9.5 h (p < 0.001). Patients below 3: 31.3/62.8% (p < 0.001). Suggestive history/radiological signs: 100%/100%, 75.7%/98.6% (p < 0.0001). Site of impaction cricopharynx: 60.3%/74.3% (p = 0.02). LBBFB group: Successful removal in 1st attempt: 66 (94.3%). Cases requiring multiple attempts due to impaction: 4 (5.7%). Parenteral steroids were administered before successful reattempt. No relation was found between duration of ingestion/impaction. Five (7.1%) cases developed complications. Average follow-up duration: 13.59 months.

CONCLUSIONS

Children <3 years with vague history of FB ingestion and suggestive chest x-ray should be sent urgently for FB removal. Parenteral pre-and postoperative short course steroid use may be considered to improve outcomes.

Is Radiologic Evaluation Necessary to Find out Foreign Bodies in Nasal Cavity?

Although there were previous studies on the clinical aspects such as etiology, treatment modalities, studies regarding the necessity of radiologic evaluation for nasal foreign body were limited. The aim of this study is to evaluate the necessity and indication of radiologic evaluation for nasal foreign bodies. There are consecutive patients aged less than 10 years who presented with suspected foreign bodies in nasal cavity. We reviewed the patient's age and sex, including the methods of evaluation, management tools, and types of foreign bodies. There were 35 cases (11.4%) on whom radiographs were performed in the 24 uncooperative patients and 11 cooperative patients who were not identified with any foreign bodies via nasal endoscopy. Among them, only 4 cases had positive reports of foreign body and the others were normal radiologic findings. We suggest that the radiologic evaluation is always not necessary to find the location of nasal foreign bodies. It, however, should be performed in cases of negative findings of physical examination with anterior rhinoscopy or sinus endoscopy and unwitnessed foreign bodies to rule out metallic contents, especially button type battery.

Identifying predictive factors for long-term complications following button battery impactions: A case series and literature review

OBJECTIVES

To complement a case series review of button battery impactions managed at our single military tertiary care center with a thorough literature review of laboratory research and clinical cases to develop a protocol to optimize patient care. Specifically, to identify predictive factors of long-term complications which can be used by the pediatric otolaryngologist to guide patient management after button battery impactions.

METHODS

A retrospective review of the Department of Defense's electronic medical record systems was conducted to identify patients with button battery ingestions and then characterize their treatment course. A thorough literature review complemented the lessons learned to identify potentially predictive clinical measures for long-term complications.

RESULTS

Eight patients were identified as being treated for button battery impaction in the aerodigestive tract with two sustaining long-term complications. The median age of the patients treated was 33 months old and the median estimated time of impaction in the aerodigestive tract prior to removal was 10.5 h. Time of impaction, anatomic direction of the battery's negative pole, and identifying specific battery parameters were identified as factors that may be employed to predict sequelae.

CONCLUSION

Based on case reviews, advancements in battery manufacturing, and laboratory research, there are distinct clinical factors that should be assessed at the time of initial therapy to guide follow-up management to minimize potential catastrophic sequelae of button battery ingestion.

Review of esophageal injuries and stenosis: Lessons learn and current concepts of management

Aim:

To review the patients with esophageal injuries and stenosis with respect to their etiology, clinical course, management, and the lessons learnt from these.

Materials and Methods:

Retrospective descriptive observation review of children with esophageal injuries and stenosis admitted between January 2009 and April 2015.

Results:

Eighteen children with esophageal injuries of varied etiology were managed and included, seven with corrosive injury, five with perforation due to various causes, three with mucosal erosion, two with trachea esophageal fistula (TEF), and one wall erosion. The five children who had perforation were due to poststricture dilatation in a child with esophageal atresia and secondary to foreign body impaction or its attempted retrieval in four. Alkaline button cell had caused TEF in two. Three congenital esophageal stenosis (CES) had presented with dysphagia and respiratory tract infection. Six corrosive stricture and two CES responded to dilatation alone and one each of them required surgery. Four of the children with esophageal perforation were detected early and required drainage procedure (1), diversion (1), and medical management (2). Pseudo diverticulum was managed expectantly. Among TEF, one had spontaneous closure and other one was lost to follow-up. All the remaining nineteen children have recovered well except one CES had mortality.

Conclusion:

Esophageal injuries though rare can be potentially devastating and life-threatening.

An incidental finding of a long-standing button battery in the floor of the nose during a routine orthodontic examination

Foreign body insertion into the ears and nose is common in children and is often witnessed by the carer or reported by the child and therefore appropriate management can be sought promptly. However, these incidents can go unreported and may be accompanied by non-specific symptoms making diagnosis difficult. Button batteries are common in everyday life and their small size and shiny appearance make them appealing to children and their ingestion or insertion is not uncommon. Due to their size, shape and electrochemical composition button batteries pose serious complications if ingested, inhaled or inserted. In the nose they usually cause intense local tissue reactions resulting in severe tissue destruction, septal necrosis or stenosis of the nasal cavity as well as posing the risk of subsequently being ingested or aspirated. This case report details an incidental finding of a button battery in the floor of the nose discovered on routine orthodontic radiographs. An upper standard occlusal and dental panoramic tomography showed a radiopaque, cylindrical, object in the floor of the nose which a subsequent CBCT localized to the floor of the right nasal fossa. The patient required orthodontic extractions and the exposure and bonding of teeth under general anaesthetic. Therefore the battery was removed by the maxillofacial surgery team at the same general anaesthetic. This is a rare case of an incidental finding of a long-standing button battery impaction which was asymptomatic and did not have any detrimental effects. This case highlights the dangers of button battery impaction and the need for prompt referral for removal.

Fluid collection in the retropharyngeal space: A wide spectrum of various emergency diseases

Fluid collections in the retropharyngeal space (RPS) result from a wide spectrum of diseases, including retropharyngeal abscess, cervical osteomyelitis, and calcific tendinitis of the longus colli muscle. These conditions should be managed by different specialties; beginning with care in the emergency room, physicians from orthopedics, pediatrics, otolaryngology, and oncology are in charge of the treatment. Since these diseases demonstrate similar fluid collections in the RPS on computed tomography (CT) and magnetic resonance imaging (MRI), the radiologist's diagnosis based on the characteristic imaging findings is very important to identify the primary disease. Also, since some of the diseases require immediate surgical intervention to avoid life-threatening mediastinitis or airway obstruction, radiologists must distinguish these diseases correctly and provide recommendations for their management to physicians. Understanding clinical features and imaging findings of these fluid collections in the RPS is crucial for the best care.

Sudden death following accidental ingestion of a button battery by a 17-month-old child: a case study

Cases of ingesting button batteries by children are not common clinical situations in forensic medicine. Although it can be a cause of death when associated with digestive perforations, no cases of sudden death have been reported in the literature. We report the case of a 17-month-old girl who presented at home with haematemesis, followed by failed cardiopulmonary resuscitation. The child had been treated on two occasions for nasopharyngitis, 14 and 18 days prior to her death. The post-mortem scan revealed a radio-opaque foreign body in the oesophagus. The autopsy revealed the presence of a round button battery, 20 mm in diameter, blocking the lumen of the oesophagus in its upper third, associated with two parietal oesophageal ruptures opposite each other. There was limited digestive haemorrhage, but above all significant bronchial inhalation of blood. Toxicology analyses showed slightly increased blood levels of the heavy metals of which the battery was composed (lithium, chromium, manganese and molybdenum). The anatomopathological analyses confirmed the recent nature of these ruptures. Ingestions of button batteries localised at the level of the oesophagus are the cases linking to the highest risk of complications, particularly for batteries with a diameter of more than 20 mm and in children under the age of 4. The main difficulty in such clinical situations is identifying when the ingestion occurred, as more often than not, no witnesses are present. We discuss the advantages of anatomopathology and toxicology examinations targeted towards heavy metals in these forensic situations.

Endoscopic removal of impacted oesophageal foreign body: A case report and a review of literature

Foreign body (FB) impaction in the oesophagus is fairly common in paediatric Gastroenterology practice. This study aims to describe a case of an unusually impacted button lithium battery, in the mid-oesophagus of a 7-year-old child that was confirmed, and removed during oesophagogastroduodenoscopy. A 7-year-old male child, presented at the Emergency Paediatric Unit of our hospital with a history of ingestion of a button-like metallic object. A plain soft tissue X-ray of the neck and chest, however, revealed a dense round object located at the sternal angle of Louis. The object was dislodged and identified as a flat lithium battery after an oesophagogastroduodenoscopy, carried out under general anaesthesia using a flexible forward-viewing video gastroscope. The button battery was subsequently passed in faeces. Endoscopic removal of impacted oesophageal FBs under general anaesthesia is an effective and safe procedure in children in experienced hands.

Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions

Gastrointestinal injuries secondary to button battery ingestions in children have emerged as a dangerous and difficult management problem for pediatricians. Implementation of a multidisciplinary team approach, with rapid and coordinated care, is paramount to minimize the risk of negative outcomes. In addition to providing a comprehensive review of the topic, this article outlines the authors' referral center's experience with patients with severe battery ingestion, highlighting the complications, outcomes, and important lessons learned from their care. The authors also propose an algorithm for clinical care that may be useful for guiding best management of pediatric button battery ingestion.

An Asymptomatic Foreign Body in the Nose in an Eighteen-Year-Old Patient: Button Battery

Foreign bodies lodged in the upper airway are a common occurrence in children. Many unusual foreign bodies in the nose have been reported as foreign bodies like nuts, plastic toy parts, beads, and so forth. Most of these produce minimal morbidity but button batteries due to their early chemical disintegration require early surgical intervention. Here, we report a case of button battery lodged in the nose for several years with a symptom of nasal obstruction and chronic sinusitis.

[Foreign bodies in ENT: ten-year experience]

Les corps étrangers (CE) représentent une pathologie fréquemment rencontrée en pratique ORL d'urgence. Ils peuvent constituer une urgence vitale par leur aspect ou leur siège. Nous présentons le bilan de dix ans sur la prise en charge des CE de la sphère ORL avec une revue de la littérature. Il s'agit d'une étude rétrospective entre Janvier 2004 et Décembre 2013, incluant tous les cas de CE des voies aéro-digestives supérieures et auriculaires colligés dans le service d'ORL au CHU Mohammed VI de Marrakech au Maroc. Sur les 1317 cas de CE de la sphère ORL colligés durant cette période, 80,48% concernaient les enfants. Le sex-ratio était de 1,5. L’âge moyen était de 12,92 ans. Les CE œsophagiens étaient les plus fréquents (47,53%). Les complications ont été rencontrées dans 11,69% des cas. Les CE dans la sphère ORL restent fréquents en pratique quotidienne surtout chez les enfants. Leur prise en charge nécessite une intervention rapide avec un matériel adapté et des médecins entrainés. La prévention reste la meilleure solution.

Vaginal Burn from Alkaline Battery in an 8-Year-Old

BACKGROUND

Life-threatening injury from battery ingestion has mandated changes in the manufacture of battery-operated devices. Whilst esophageal burns are commonly publicized, there is scarce literature on vaginal burns and their potential morbidity.

CASE

An 8-year-old girl presented with self-report of a "fluffy toy" per vagina. Under general anesthesia, her vagina was examined and the mucosa appeared coated in a "blue fur." It was soon identified as corrosive damage from an alkaline button battery. Fistula and rectal injury were excluded. Symptomatic relief was achieved with the use of estradiol lidocaine intravaginal concoction following removal.

SUMMARY AND CONCLUSIONS

Optimal management of a vaginal foreign body relies upon clinical suspicion, familiarity with prepubertal vaginal instrumentation, and expeditious removal of inserted batteries to avoid serious morbidity.

Difficult button battery ear foreign body removal: the magnetic solution

Background:

Removing a button battery from the ear can be a tricky and challenging procedure.

Method and Results:

We describe the innovative use of a magnetic telescopic rod to successfully remove a button battery from the ear canal of a nine-year-old boy.

Conclusion:

We propose that this equipment should be available in ENT clinics and operating theatres to be used for removing foreign bodies made from ferrous materials.

How did that get there? A population-based analysis of nasal foreign bodies

BACKGROUND

The purpose of this study was to calculate nationwide incidence of emergency department (ED) visits for nasal foreign bodies, identify the most frequently encountered consumer products, and evaluate outcomes and demographic trends.

METHODS

The Nationwide Electronic Injury Surveillance System (NEISS) was evaluated for ED visits related to nasal foreign bodies for the most recent 5-year span available. Nationwide incidence was calculated, and the most frequent foreign bodies were identified and organized by demographics including age and gender.

RESULTS

A total of 6418 entries extrapolated to an estimated 198,566 ED visits nationwide were found. Out of individual case entries evaluated, median patient age was 3 years, and 42.7% of patients were male. Ninety-six percent (96.4%) of patients were released after examination/treatment. Jewelry beads comprised a plurality of nasal foreign bodies, followed by paper products and toys. Patients with nasal foreign bodies involving toys, building sets, pens/pencils, batteries, coins, and nails/screws were predominantly male, whereas patients with nasal foreign bodies involving jewelry, paper products, and buttons were predominantly female. Jewelry was the most common item for patients in most age groups; age-specific differences in the composition of remaining nasal foreign bodies were noted.

CONCLUSION

A variety of consumer products carry inherent risks for becoming nasal foreign bodies, with nearly 200,000 ED visits over a 5-year period. Jewelry beads, paper products, and toys were the most common products noted. Speedy recognition and retrieval of these items and other objects noted is imperative for avoidance of deleterious sequelae. Demographic-specific trends noted and organized by age and gender may be an invaluable adjunct for patient history-taking and clinical examination.