1
|
Ren S, Lopes H, Masters N. Video Laryngoscope Assistance in Button Battery Retrieval. Case Rep Anesthesiol 2023; 2023:8550685. [PMID: 37711750 PMCID: PMC10499533 DOI: 10.1155/2023/8550685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Foreign body ingestion remains a common cause of pediatric emergency surgery with button battery ingestion of particular concern. Newer, higher power lithium batteries can cause catastrophic damage of the gastrointestinal tract through erosion of mucosa into surrounding structures. Prompt diagnosis and treatment are paramount. We present a case of an 11-month-old with a button battery lodged in the proximal esophagus. The extraction was difficult and only made possible with the assistance of a video laryngoscope. We make the case for more routine usage of video laryngoscopy for removal of foreign bodies in the upper esophagus.
Collapse
Affiliation(s)
- Sandy Ren
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, Miami, Florida, USA
| | - Heitor Lopes
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, Miami, Florida, USA
| | - Neil Masters
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, Florida, USA
| |
Collapse
|
2
|
Akinkugbe O, James AL, Ostrow O, Everett T, Wolter NE, McKinnon NK. Vascular Complications in Children Following Button Battery Ingestions: A Systematic Review. Pediatrics 2022; 150:189222. [PMID: 36032017 DOI: 10.1542/peds.2022-057477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children presenting to health care facilities with button battery (BB) impaction. OBJECTIVES To describe characteristics of children with vascular complications after BB impaction, as well as associated outcomes. DATA SOURCES National Capital Poison Center registry and PubMed database from inception to December 2021. STUDY SELECTION All reports describing children aged <18 years with vascular, esophageal, or airway complications after BB ingestion. DATA EXTRACTION We extracted characteristics including date of publication, age and sex of child, battery type and size, duration and location of impaction, complications, subsequent interventions, and interval between battery removal and death. RESULTS A total of 361 cases involved severe complications or death after BB ingestion (321 cases from the National Capital Poison Center registry database, 40 additional cases from PubMed). Nineteen percent (69 of 361) were fatal and 14% (51 of 361) involved vascular injuries. Three-quarters (75%) of vascular complications were aorto-esophageal fistulae and 82% of vascular injuries were not survivable. Fatal vascular cases had significantly longer median impaction time (96 hours versus 144 hours, P <.05) and a wider range of presenting features than survivors. LIMITATIONS The total number of cases with vascular complications was small, data reported varied between cases, and no data were available on overall exposure. Long-term morbidity data were not available for the survivors. CONCLUSIONS Prolonged BB impaction is a risk factor for vascular complications and death. A high index of suspicion is required for children representing with hematemesis after BB impaction, with prompt transfer to a tertiary center because vascular surgical intervention may offer a chance of survival.
Collapse
Affiliation(s)
| | | | - Olivia Ostrow
- Pediatrics, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nicole K McKinnon
- Departments of Critical Care Medicine.,Department of Neuroscience and Mental Health, Peter Gilgan Center for Research and Learning, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Magnetic resonance imaging of children following esophageal button battery removal: What are we looking for? Clin Imaging 2022; 86:71-74. [DOI: 10.1016/j.clinimag.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
|
4
|
Atlas N, Sinclair EM, Simon HK, Riedesel EL, Figueroa J, Kamat PP, Santore MT. Management of esophageal button battery ingestions: resource utilization and outcomes. Pediatr Surg Int 2022; 38:473-478. [PMID: 35088154 DOI: 10.1007/s00383-021-05058-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Institutions are adopting the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for pediatric esophageal button battery ingestion (EBBI). Our objective was to evaluate the guidelines' impact on in-hospital resource utilization and short-term clinical outcomes in hemodynamically stable patients after endoscopic battery removal. METHODS A single-center retrospective review of all EBBI admissions from 2010 to 2020. Patients were divided into two groups based on adoption of national guidelines: pre-guideline (2010-2015) and post-guideline (2016-2020). RESULTS Sixty-five patients were studied (pre-guideline n = 23; post-guideline n = 42). Compared with pre-guideline, post-guideline use of magnetic resonance imaging (MRI) increased (2/23 [8.7%]; 30/42 [71.4%]; p < 0.001). Post-guideline increases resulted for median days (IQR) receiving antibiotics (0 [0, 4]; 6 [3, 8]; p = 0.01), total pediatric intensive care unit admission (0 [0, 1]; 3 [0, 6]; p < 0.001), and total hospital length of stay (5 [2, 11]; 11.5 [4, 17]; p = 0.02). Two patients in the post-guideline group had delayed presentations despite normal imaging: one with TEF and one with aorto-esophageal fistula. All survived to discharge. CONCLUSION In EBBI cases managed using the consensus based NASPHAGN guidelines, we report increased resource utilization without improved patient outcomes. Further research should evaluate post-guideline costs and resource utilization.
Collapse
Affiliation(s)
- Nir Atlas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Elizabeth M Sinclair
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Harold K Simon
- Division of Pediatric Emergency Medicine, Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Erica L Riedesel
- Division of Pediatric Radiology and Imaging, Department of Radiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Janet Figueroa
- Department of Pediatrics, Pediatric Biostatistics Core at Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Pradip P Kamat
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA. .,Children's Healthcare of Atlanta, 4th Floor PICU, 1405 Clifton Rd NE, Atlanta, GA, USA.
| | - Matthew T Santore
- Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA
| |
Collapse
|
5
|
Sinclair EM, Santore MT, Agarwal M, Kitzman J, Sauer CG, Riedesel EL. Evolving Clinical Care in Esophageal Button Batteries: Impact of Expert-Opinion Guideline Adoption and Continued Gaps in Care. J Pediatr Gastroenterol Nutr 2022; 74:236-243. [PMID: 34724451 PMCID: PMC8799493 DOI: 10.1097/mpg.0000000000003346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Esophageal button battery impactions (BBI) in children pose a significant danger to children. Although there are expert-opinion guidelines to help manage this population, few studies detail the impact of guidelines on the clinical care of these patients. With this study, we aimed to describe the care of these patients before and following adoption of guidelines at a single center. METHODS Retrospective cohort study of patients with esophageal BBI at a single center, large volume, urban academic pediatric hospital system before adoption of expert-opinion guidelines (2007-2017) and following adoption (2018-2020). RESULTS Cohort was comprised of 31 patients before adoption and 32 patients following adoption of guidelines. Patient characteristics did not differ between groups. After 2018, significantly more patients received acetic acid irrigation, initial cross-sectional imaging, and serial cross-sectional imaging. There was also an increase in intensive care unit (ICU) stays, number of intubations, nil per os time, and hospital length of stay. There was no difference in patient outcomes. CONCLUSION This study describes a large cohort of pediatric esophageal BBI before and following adoption of guidelines. Findings detail increased adherence to guidelines resulting in more cross-sectional imaging which led to ICU stays, longer length of stays, and more nil per os time. This study emphasizes the need for multi-disciplinary guidelines as well as further multi-institutional study.
Collapse
Affiliation(s)
| | | | | | - Jamie Kitzman
- Pediatric Anesthesiology, Department of Anesthesiology and Pediatrics
| | - Cary G Sauer
- Pediatric Gastroenterology, Department of Pediatrics
| | - Erica L Riedesel
- Pediatric Radiology, Department of Radiology and Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
6
|
Yogev D, Lev-Tzion R, Ledder O, Orlanski-Meyer E, Zharkov E, Cytter-Kuint R. Retained metal fragments following esophageal button battery impaction. Eur J Pediatr 2022; 181:143-147. [PMID: 34223968 DOI: 10.1007/s00431-021-04184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
Button battery (BB) impaction in the esophagus requires immediate endoscopic removal and meticulous follow-up, including serial cross-sectional imaging, preferably with magnetic resonance imaging (MRI). However, BBs quickly degrade in the esophagus, and metallic fragments may remain in the injured mucosa following removal. This metallic debris can cause thermal injury during MRI, potentially aggravating local injury. We aimed to explore whether such metallic fragments could be identified on imaging following BB removal. In this study, we conducted a retrospective review of children (0-18 years) presenting with BB impaction in the esophagus between 2014 and 2020. Endoscopy reports and imaging studies were blindly reviewed by a pediatric gastroenterologist and a pediatric radiologist. Of 161 cases of battery ingestion, 14 (8%) underwent endoscopy, and in 9 (5%) a BB was impacted in the esophagus. The median time from ingestion to BB removal was 8 h (range 2-48 h). The median time from removal to CT was 44 h (range 0.5-104 h). BB appearance ranged from mild corrosion to visible debris. Pre-removal plain films showed irregular battery contour suggesting corrosion (5/7 plain films). In 7/9 CT scans (78%), high-attenuation esophageal content (median 266HU (range 140-1151)), which may represent metallic debris, was identified. Five patients had a follow-up CT which still showed gradual resolution of the high-attenuation content.Conclusions: we describe a new finding on CT following BB removal which might represent metallic debris. Clinicians should be aware of these findings which potentially may be harmful during MRI used in the ongoing assessment of esophageal injury. What is Known: • Button batteries are a dangerous pediatric foreign body with potentially fatal vascular complications. What is New: • Metallic debris was identified on computerized tomography following button battery removal in most children. • We bring to attention this new finding which may affect clinical management, as minimal metallic content can cause burns during MRI.
Collapse
Affiliation(s)
- Dotan Yogev
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raffi Lev-Tzion
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Oren Ledder
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Orlanski-Meyer
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elena Zharkov
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ruth Cytter-Kuint
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. .,Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel.
| |
Collapse
|
7
|
Survival of Toddler with Aortoesophageal Fistula after Button Battery Ingestion. Case Rep Otolaryngol 2021; 2021:5557054. [PMID: 34650821 PMCID: PMC8510820 DOI: 10.1155/2021/5557054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022] Open
Abstract
Button batteries (BBs) are found in many households and are a source of esophageal foreign body in the pediatric population. Upon ingestion, significant caustic injury can occur within 2 hours leading to tissue damage and severe, potentially fatal sequelae. Aortoesophageal fistula (AEF) is a rare complication that nearly always results in mortality. We report a rare case of a toddler who developed an AEF after BB ingestion and survived following staged aortic repair. There should be a high index of suspicion for this complication with the history of BB ingestion and presence of hematemesis, hemoptysis, or melena.
Collapse
|
8
|
Magnetic resonance imaging findings following button battery ingestion. Pediatr Radiol 2021; 51:1856-1866. [PMID: 34075452 DOI: 10.1007/s00247-021-05085-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/05/2021] [Accepted: 04/20/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Lithium button battery ingestions have been increasing in frequency since the early 2000s and can develop severe and sometimes fatal complications from caustic injury even after rapid battery removal. To aid in clinical decision-making, we began obtaining magnetic resonance imaging (MRI)/MR angiography in these patients. OBJECTIVE Our goal was to review MRI/MR angiography imaging in button battery ingestion cases and compare with other imaging, clinical data and outcomes in these patients. MATERIALS AND METHODS In this retrospective institutional-review-board-approved study, we reviewed all button battery ingestion cases with MRI from April 2012 to September 2018. Clinical data, endoscopic findings and all imaging studies were rereviewed. MRIs were evaluated for inflammation, blooming artifact and complications including vascular injury, tracheoesophageal fistula, esophageal perforation and spondylodiscitis, and compared to endoscopy, esophagram and bronchoscopy. RESULTS Twenty-three patients with button battery ingestions had a total of 51 MRI/MR angiograms. Seventy percent of the cohort was male with a median age of 2 years (range: 0.94-17 years). Severe complications were found in 48% of patients (11/23), including esophageal perforation (n=11), tracheoesophageal fistula (n=3) and spondylodiscitis (n=1). No patients had vascular injury. Cervical location of the battery was significantly associated with severe complications (10/11 cases). The length of the blooming artifact was greater than 2 cm in those with severe complications and, in most cases, <2 cm in those without severe complications. All complications were seen on initial screening MR exam with serial exams showing decreased inflammation. CONCLUSION MRI/MR angiography can provide valuable information about complications, including esophageal perforation, tracheoesophageal fistula and spondylodiscitis. Decreasing inflammation surrounding the esophagus and vasculature is believed to be clinically reassuring and aids in managing button battery ingestion patients.
Collapse
|
9
|
Optimized Fuzzy C-Means Algorithm-Based Coronal Magnetic Resonance Imaging Scanning in Tracheal Foreign Bodies of Children. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5678994. [PMID: 34306593 PMCID: PMC8279863 DOI: 10.1155/2021/5678994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/24/2021] [Accepted: 06/18/2021] [Indexed: 01/04/2023]
Abstract
In order to provide theoretical support for clinical diagnosis, the diagnostic value of the optimized fuzzy C-means (FCM) algorithm combined with coronal magnetic resonance imaging (MRI) scan was investigated in the diagnosis of tracheal foreign bodies in children. The anisotropic filtering was applied to optimize the traditional FCM algorithm, so as to construct a new MRI image segmentation algorithm, namely, AFFCM algorithm. Then, the traditional FCM algorithm, the FCM algorithm based on the kernel function (KFCM), and the FCM algorithm based on the spatial neighborhood information (RFCM) were introduced for comparison with the AFFCM. 28 children diagnosed with foreign bodies in the trachea were selected for MRI diagnosis, and AFFCM was used for segmentation. The partition coefficient, segmentation entropy, and the correlation degree between classes after fuzzy division of the four algorithms were recorded, and the location and distribution of foreign bodies in the trachea and the types of foreign bodies were also collected. Besides, the MRI scanning and chest X-rays of the children with foreign bodies in the trachea should also be recorded in terms of the positive rate, diagnosis rate, and indirect signs. The class division coefficient and interclass correlation degree after fuzzy division of AFFCM were markedly greater than those of FCM, KFCM, and RFCM (P < 0.05), while the segmentation entropy of AFFCM was less sharp than the entropies of FCM, KFCM, and RFCM (P < 0.05). Among the 28 children, there were 5 cases with foreign bodies in the trachea (17.86%), 10 cases in the left bronchus (35.71%), and 13 cases in the right bronchus (46.43%). Among the foreign body types, there were 10 cases of melon seeds (35.71%), 6 cases of peanuts (21.43%), and 5 cases of beans (17.86%). The positive rate (89.29%) and diagnosis rate (96.43%) of MRI for bronchial foreign bodies increased obviously in contrast to the rates of X-ray chest radiographs (57.14% and 67.86%) (P < 0.05). Therefore, it was indicated that AFFCM showed higher partition coefficient value, lower segmentation entropy, larger similarity among classes, and better image segmentation effect. Furthermore, AFFCM-based coronal MRI scan had a higher positive rate and diagnosis rate for children's tracheal foreign bodies, and the main signs were emphysema and atelectasis.
Collapse
|
10
|
Sinclair EM, Stevens JP, McElhanon B, Meisel JA, Santore MT, Chahine AA, Riedesel EL. Development and repair of aorto-esophageal fistula following esophageal button battery impaction: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 66. [PMID: 33767967 PMCID: PMC7990103 DOI: 10.1016/j.epsc.2021.101782] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Complications from esophageal button battery impactions remain a real fear for practicing pediatric gastroenterologists and surgeons. This case describes a child who developed an aorto-esophageal fistula 25 days after initial battery ingestion and survived due to prompt placement of an aortic stent via minimally invasive surgery, avoiding an open procedure. Case presentation: A 6-year-old female presented acutely with a mid-esophageal button battery impaction witnessed by her parents. Presenting symptoms included chest pain and emesis. Button battery location and size were confirmed on X-ray. She underwent removal with flexible esophagogastroduodenoscopy (EGD) and rigid esophagoscopy. She was admitted to the hospital and received conservative medical management, with serial cross-sectional imaging via chest MRIs to assess the evolution of her injury according to available national guidelines, and was discharged after 12 days of close inpatient monitoring. Despite these measures the patient represented 25 days post-ingestion with hematemesis from a new aorto-esophageal fistula, requiring emergent cardiac catheterization with successful, life-saving aortic stent placement. She remained admitted for an additional 12 days of monitoring as her diet was advanced slowly post-catheterization. Since this second hospitalization she continues to do well, with outpatient follow-up by multiple subspecialists. Conclusions: This case highlights the continued uncertainty regarding the risk of developing this complication, as well as gaps in the current literature and guidelines for managing these patients following ingestion and esophageal injury. It also details the unique course following development of this complication and its surgical repair.
Collapse
Affiliation(s)
- Elizabeth M. Sinclair
- Pediatric Gastroenterology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Corresponding author. Emory University School of Medicine, Pediatric Divisions of Gastroenterology, Hepatology, and, Nutrition Emory Children’s Center 2015 Uppergate Dr. NE, Atlanta, GA 30322, USA. (E.M. Sinclair)
| | - James P. Stevens
- Pediatric Gastroenterology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Barbara McElhanon
- Pediatric Gastroenterology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan A. Meisel
- Pediatric Surgery, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew T. Santore
- Pediatric Surgery, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - A. Alfred Chahine
- Pediatric Surgery, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Erica L. Riedesel
- Pediatric Radiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|