Sudden onset of aphagia in childhood

Introduction:

Ingestion and aspiration of small parts belong to the most common emergencies in pediatrics. Swallowing of big button batteries is of increasing relevance because they are used more and more to power toys and household appliances and often cause severe complications.

Case report:

A 20-months-old boy was brought to the emergency room by ambulance after he, witnessed by his parents, had swallowed a button battery half an hour ago. He had vomited twice, otherwise there were no signs of distress. An X-ray was performed on which a round, coin-sized foreign body could be seen in the proximal esophagus. Due to an unknown cardial condition and the lack of an interpreter the preparation for surgical removal was delayed significantly. At the time of the esophagoscopy, three hours after ingestion had taken place, there was already severe mucosal corrosion on a stretch of approximately 10 cm. Several sodium chloride flushes were needed before the stenosis could be passed with the endoscope. During the ensuing time of hospitalization, repeated endoscopic evaluations were performed. On day 11 after removal, an esophageal stricture had developed which was then treated by dilation. As the definite outcome is still unknown, it is most likely that the patient will suffer from the consequences of esophageal corrosion for a long time.

Conclusion:

Whenever ingestion of a button battery is suspected, X-ray and endoscopic removal should be prepared immediately. Unnecessary delays in diagnostics and treatment should be avoided as the probability of severe complications increases significantly from 2 hours after ingestion.

Publication History

Publication Date:
23 May 2018 (online)