Conservative management of an acquired tracheoesophageal fistula caused by a swallowed button battery: A case report
The incidence of pediatric button battery (BB) ingestions has increased in recent years with a subsequent rise in secondary esophageal injuries. There is a paucity of published literature on the evaluation and management of acquired trachea-esophageal fistulas (TEF) in this context and therefore, th...
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Published in | Journal of pediatric surgery case reports Vol. 101; p. 102761 |
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Abstract | The incidence of pediatric button battery (BB) ingestions has increased in recent years with a subsequent rise in secondary esophageal injuries. There is a paucity of published literature on the evaluation and management of acquired trachea-esophageal fistulas (TEF) in this context and therefore, the purpose of this paper was to summarize a case and propose an evidence-based protocol for acquired TEF management.
A 15-month-old female presenting with fever, mild tachypnea and lethargy underwent a chest x-ray which demonstrated a BB in the upper thorax. Laryngoscopy, and subsequent rigid esophagoscopy, identified the BB in the proximal esophagus. There was surrounding inflammation and liquefactive necrosis, and the BB was removed via rigid esophagoscopy. A post-procedure chest computerized tomography following BB removal revealed a small collection in the mediastinum consistent with full thickness esophageal perforation as well as mediastinitis. She was treated conservatively and on post-operative day (POD) 7, a swallow study demonstrated no evidence of leak or stricture, thus a trial of oral, clear fluids took place. A next-day repeat swallow study was performed and revealed an acquired TEF. She was treated conservatively with proton pump inhibitor and nasojejunal feeds. Bronchoscopy, upper gastrointestinal endoscopy and repeat esophagram at six-weeks demonstrated resolution of the TEF.
Clinicians should have a high index of suspicion for BB ingestion complications, even after removal. This case illustrated that patients with acquired TEF can be managed conservatively. Following literature review and our personal experience in this single case, we propose a suggested algorithm for management of these patients. |
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AbstractList | The incidence of pediatric button battery (BB) ingestions has increased in recent years with a subsequent rise in secondary esophageal injuries. There is a paucity of published literature on the evaluation and management of acquired trachea-esophageal fistulas (TEF) in this context and therefore, the purpose of this paper was to summarize a case and propose an evidence-based protocol for acquired TEF management.
A 15-month-old female presenting with fever, mild tachypnea and lethargy underwent a chest x-ray which demonstrated a BB in the upper thorax. Laryngoscopy, and subsequent rigid esophagoscopy, identified the BB in the proximal esophagus. There was surrounding inflammation and liquefactive necrosis, and the BB was removed via rigid esophagoscopy. A post-procedure chest computerized tomography following BB removal revealed a small collection in the mediastinum consistent with full thickness esophageal perforation as well as mediastinitis. She was treated conservatively and on post-operative day (POD) 7, a swallow study demonstrated no evidence of leak or stricture, thus a trial of oral, clear fluids took place. A next-day repeat swallow study was performed and revealed an acquired TEF. She was treated conservatively with proton pump inhibitor and nasojejunal feeds. Bronchoscopy, upper gastrointestinal endoscopy and repeat esophagram at six-weeks demonstrated resolution of the TEF.
Clinicians should have a high index of suspicion for BB ingestion complications, even after removal. This case illustrated that patients with acquired TEF can be managed conservatively. Following literature review and our personal experience in this single case, we propose a suggested algorithm for management of these patients. Introduction: The incidence of pediatric button battery (BB) ingestions has increased in recent years with a subsequent rise in secondary esophageal injuries. There is a paucity of published literature on the evaluation and management of acquired trachea-esophageal fistulas (TEF) in this context and therefore, the purpose of this paper was to summarize a case and propose an evidence-based protocol for acquired TEF management. Case presentation: A 15-month-old female presenting with fever, mild tachypnea and lethargy underwent a chest x-ray which demonstrated a BB in the upper thorax. Laryngoscopy, and subsequent rigid esophagoscopy, identified the BB in the proximal esophagus. There was surrounding inflammation and liquefactive necrosis, and the BB was removed via rigid esophagoscopy. A post-procedure chest computerized tomography following BB removal revealed a small collection in the mediastinum consistent with full thickness esophageal perforation as well as mediastinitis. She was treated conservatively and on post-operative day (POD) 7, a swallow study demonstrated no evidence of leak or stricture, thus a trial of oral, clear fluids took place. A next-day repeat swallow study was performed and revealed an acquired TEF. She was treated conservatively with proton pump inhibitor and nasojejunal feeds. Bronchoscopy, upper gastrointestinal endoscopy and repeat esophagram at six-weeks demonstrated resolution of the TEF. Conclusion: Clinicians should have a high index of suspicion for BB ingestion complications, even after removal. This case illustrated that patients with acquired TEF can be managed conservatively. Following literature review and our personal experience in this single case, we propose a suggested algorithm for management of these patients. |
ArticleNumber | 102761 |
Author | Vucenovic, Danielle Seemann, Natashia M. Woolfson, Jessica P. Strychowsky, Julie E. Jegatheeswaran, Kizanee Price, April K. |
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Cites_doi | 10.1002/ppul.22858 10.1016/j.jpedsurg.2011.06.025 10.1177/1756283X12467564 10.1097/MPG.0000000000000729 10.1001/jamaoto.2022.0848 10.1007/s00383-003-1129-8 10.1097/MPG.0000000000003048 10.1097/PEC.0000000000001413 10.1016/j.giec.2015.08.003 10.1002/lary.27904 10.4103/0974-2700.142773 10.1016/j.jpedsurg.2017.03.048 10.1016/j.jemermed.2010.02.027 10.1016/j.ijporl.2008.01.015 |
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Keywords | Acquired tracheoesophageal fistula Case report Conservative management Button battery ingestion |
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management of severe pediatric foreign body ingestions publication-title: Gastrointest Endosc Clin N Am doi: 10.1016/j.giec.2015.08.003 contributor: fullname: Leinwand – volume: 129 year: 2019 ident: 10.1016/j.epsc.2023.102761_bib9 article-title: Initial clinical application of tissue pH neutralization after esophageal button battery removal in children publication-title: Laryngoscope doi: 10.1002/lary.27904 contributor: fullname: Jatana – volume: 7 year: 2014 ident: 10.1016/j.epsc.2023.102761_bib11 article-title: Severe esophageal injuries caused by accidental button battery ingestion in children publication-title: J Emergencies, Trauma, Shock doi: 10.4103/0974-2700.142773 contributor: fullname: Fuentes – volume: 52 year: 2017 ident: 10.1016/j.epsc.2023.102761_bib19 article-title: Recurrent and acquired tracheoesophageal fistulae (TEF)—minimally invasive management publication-title: J Pediatr Surg doi: 10.1016/j.jpedsurg.2017.03.048 contributor: fullname: Nazir – volume: 6 year: 2021 ident: 10.1016/j.epsc.2023.102761_bib8 article-title: Current management of button battery injuries publication-title: Laryngoscope Investig Otolaryngol contributor: fullname: Sethia – volume: 41 year: 2011 ident: 10.1016/j.epsc.2023.102761_bib2 article-title: Neck pain and stiffness in a toddler with history of button battery ingestion publication-title: J Emerg Med doi: 10.1016/j.jemermed.2010.02.027 contributor: fullname: Tan – volume: 72 year: 2008 ident: 10.1016/j.epsc.2023.102761_bib18 article-title: Acquired tracheoesophageal fistula following disc-battery ingestion: can we watch and wait? publication-title: Int J Pediatr Otorhinolaryngol doi: 10.1016/j.ijporl.2008.01.015 contributor: fullname: Grisel |
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Snippet | The incidence of pediatric button battery (BB) ingestions has increased in recent years with a subsequent rise in secondary esophageal injuries. There is a... Introduction: The incidence of pediatric button battery (BB) ingestions has increased in recent years with a subsequent rise in secondary esophageal injuries.... |
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SubjectTerms | Acquired tracheoesophageal fistula Button battery ingestion Case report Conservative management |
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Title | Conservative management of an acquired tracheoesophageal fistula caused by a swallowed button battery: A case report |
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