Year 2016 / Volume 108 / Number 12
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Caustic esophageal injury by impaction of cell batteries

811-812

Francisco José García Fernández, Rafael León Montañés, Juan Manuel Bozada Garcia,

Abstract
The ingestion of cell batteries can cause serious complications (fistula, perforation or stenosis) at the esophageal level. The damage starts soon after ingestion (approximately 2 hours) and is directly related to the amount of time the battery is lodged in said location, the amount of electrical charge remaining in the battery, and the size of the battery itself. Injury is produced by the combination of electrochemical and chemical mechanisms and pressure necrosis. The ingestion of multiple cells and a size > = 20 mm are related with more severe and clinically significant outcomes. A female patient, 39 years old, with a history of previous suicide attempts, was admitted to the Emergency Room with chest pain and dysphagia after voluntary ingestion of 2 cell batteries. Two cell batteries are easily detected in a routine chest X-ray, presenting a characteristic double-ring shadow, or peripheral halo. Urgent oral endoscopy was performed 10 hours after ingestion, showing a greenish-gray lumpy magma-like consistency due to leakage of battery contents. The 2 batteries were sequentially removed with alligator-jaw forceps. After flushing and aspiration of the chemical material, a broad and circumferential injury with denudation of the mucosa and two deep ulcerations with necrosis were observed where the batteries had been. The batteries’ seals were eroded, releasing chemical contents. Despite the severity of the injuries, the patient progressed favorably and there was no esophageal perforation. Esophageal impaction of cell batteries should always be considered an endoscopic urgency.
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References
1. Litovitz T, Whitaker N, Clark L. Preventing battery ingestions: an analysis of 8648 cases. Pediatrics 2010; 125:1178-83.
2. Kimball SJ, Park AH, Rollins MD 2nd, et al. A review of esophageal disc battery ingestions and a protocol for management. Arch Otolaryngol Head Neck Surg 2010; 136:866-71
3. "NBIH Button battery ingestion triage and treatment guideline". National Capital Poison Center. www.poison.org/battery/guideline.asp (last accessed November 17th, 2015).
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García Fernández F, León Montañés R, Bozada Garcia J. Caustic esophageal injury by impaction of cell batteries. 4120/2015


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Publication history

Received: 21/11/2015

Accepted: 06/12/2015

Published: 30/11/2016

Article editing time: 375 days


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