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CASE REPORT Table of Contents   
Year : 2016  |  Volume : 13  |  Issue : 1  |  Page : 41-43
Endoscopic removal of impacted oesophageal foreign body: A case report and a review of literature


1 Department of Medicine, Gastroenterology Unit, Federal Medical Centre, Lokoja, Nigeria
2 Department of Paediatrics, Federal Medical Centre, Lokoja, Nigeria
3 Department of Medicine, Gastrointestinal Unit, University of Ilorin Teaching Hospital, Ilorin, Nigeria

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Date of Web Publication3-May-2016
 

   Abstract 

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.

Keywords: Button battery, endoscopic retrieval, foreign body, impacted, oesophagus

How to cite this article:
Obateru OA, Durowaye MO, Olokoba AB, Olaniyi OK. Endoscopic removal of impacted oesophageal foreign body: A case report and a review of literature. Afr J Paediatr Surg 2016;13:41-3

How to cite this URL:
Obateru OA, Durowaye MO, Olokoba AB, Olaniyi OK. Endoscopic removal of impacted oesophageal foreign body: A case report and a review of literature. Afr J Paediatr Surg [serial online] 2016 [cited 2019 Dec 14];13:41-3. Available from: http://www.afrjpaedsurg.org/text.asp?2016/13/1/41/181706

   Introduction Top


Ingestion of foreign bodies (FBs) is a familiar problem in Paediatric practice. [1] Demand and usage of button batteries have risen due to the increase in the usage of technological devices. [2] They are frequently inadvertently placed by children in their ears, noses and mouth, and occasionally are swallowed and lodged along the upper aerodigestive tract. [2],[3],[4] There is a paucity of data on endoscopic removal of impacted oesophageal FBs from this part of the country.

The aim of this study is 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 using a flexible forward-viewing video gastroscope.


   Case Report Top


A 7-year-old boy presented to our Emergency Paediatric Unit with a 10-h history of ingestion of a button-like metallic object. He started vomiting repeatedly following the ingestion, and also developed pain in the throat with associated dysphagia. There was no difficulty with breathing.

At presentation, the child was conscious, not in respiratory distress and not dehydrated. The oral cavity was normal with no visible foreign objects. A general physical examination was normal. A plain radiograph of the neck and chest revealed a rounded radio-opaque object located at the sternal angle of Louis [Figure 1].
Figure 1: Chest X-ray showing the radio-opaque foreign body

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An oesophagogastroduodenoscopy carried out under general anaesthesia revealed a flat round slippery metallic object covered with ingested food that was impacted at the mid-oesophagus [Figure 2].
Figure 2: Oesophagogastroduodenoscopy showing infl ammatory changes and ulcers at the point of impaction in the mid-oesophagus

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There were inflammatory changes and superficial ulcers at the point of impaction in the oesophagus [Figure 2]. The rounded metallic object was dislodged with an endoscopic grasping forceps and pushed down the oesophagus through the stomach into the second part of the duodenum. The child eventually passed the object out with faeces, about 24 h after endoscopy [Figure 3]. The object was identified to be a button lithium battery [Figure 4]. He was discharged on the 3 rd day of admission. He is being followed up in the paediatric out-patient clinic.
Figure 3: The rounded metallic object passed with faeces

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Figure 4: The button lithium battery

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   Discussion Top


Ingestion of FBs is a familiar problem in Paediatric practice. [1] Demand and usage of button batteries have risen due to the increase in the usage of technological devices. [2] They are frequently inadvertently placed by children in their ears, noses and mouth, and occasionally are swallowed and lodged along the upper aerodigestive tract. [2],[3],[4] Button batteries represent about 2% of all FBs, although this percentage seems to be increasing. [5],[6] Button battery ingestion occurs most commonly in male children, younger than 3 years with increasing severity and mortality for children younger than 4 years. [5],[6],[7],[8] Our patient is a 7-year-old male child who ingested a round flat shaped lithium-battery. Button batteries represent a low percentage of all FBs swallowed by children, and the oesophageal location is even less frequent. [5] Majority of ingested FBs pass along the gastrointestinal (GI) tract without causing any symptoms or complications. [9] Swallowed button batteries rarely remain in the oesophagus due to its smooth surface and edge and the presence of saliva, may also serve as a lubricant, which facilitate its passage down to the stomach. However, it has been reported that possible locations of impaction of ingested FBs in the oesophagus are the thoracic outlet, mid-oesophagus and lower oesophageal sphincter. [6] The battery ingested by this 7-year-old male child that got lodged at the mid-oesophagus might have been bigger than the diameter of the oesophagus at that point. This may be responsible for the impaction of the button battery which had to be dislodged, and pushed down into the stomach through to the duodenum. Button lithium batteries represent a distinct type of FB. Serious complications such as oesophageal burns, voltage discharge, erosions, ulcers, oesophageal perforation, tracheo-oesophageal fistula and stenosis could occur due to the chemical composition of the battery, particularly when the battery is impacted in the oesophagus. [2],[6],[10],[11],[12] There were ulcers in the oesophagus at the point of impaction of the lithium battery in our patient [Figure 2]. Although some patients who have impacted oesophageal FBs may be asymptomatic, others present with respiratory distress, tachypnoea, wheezing, stridor, dysphagia, coughing, drooling, etc. [6] Our patient presented with vomiting, pain and dysphagia. Ingested FBs that get impacted in the oesophagus or other parts of the GI tract require urgent endoscopic removal where such facilities are available. Flexible endoscopy is the therapeutic modality of choice for most patients. The use of devices such as a latex protector hood or an overtube may facilitate safer extraction of sharp objects if it is available. Our patient had urgent therapeutic oesophagogastroduodenoscopy with a flexible forward-viewing video gastroscope under general anaesthesia within hours of presentation. The lithium battery was dislodged and pushed down through the stomach to the duodenum. This led to immediate symptom relief and the passage of the button lithium battery in faeces about 24 h later [Figure 3] and [Figure 4]. The patient remained stable and was discharged about 24 h thereafter. He was subsequently followed up in the paediatric out-patient clinic.

There is a paucity of data on similar studies with which to compare, and this is the first reported case of endoscopic removal button lithium battery impaction in the oesophagus in this part of the country.


   Conclusion Top


Endoscopic removal of impacted oesophageal FBs under general anaesthesia is an effective and safe procedure in children in experienced hands. This procedure also prevents erosion and perforation of the GI tract. Impacted lithium battery oesophageal FBs require urgent endoscopic removal, which is the best modality of treatment to prevent imminent complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Michaud L, Bellaïche M, Olives JP; Groupe Francophone d'Hépatologie, Gastroentérologie et Nutrition Pédiatriques (GFHGNP). Ingestion of foreign bodies in children. Recommendations of the French-speaking Group of Pediatric Hepatology, Gastroenterology and Nutrition. Arch Pediatr 2009; 16:54-61.  Back to cited text no. 1
    
2.
Thabet MH, Basha WM, Askar S. Button battery foreign bodies in children: Hazards, management, and recommendations. Biomed Res Int 2013;2013:846091.  Back to cited text no. 2
    
3.
Higo R, Matsumoto Y, Ichimura K, Kaga K. Foreign bodies in the aerodigestive tract in pediatric patients. Auris Nasus Larynx 2003;30:397-401.  Back to cited text no. 3
    
4.
Premachandra DJ, McRae D. Severe tissue destruction in the ear caused by alkaline button batteries. Postgrad Med J 1990;66:52-3.  Back to cited text no. 4
    
5.
Litovitz T, Schmitz BF. Ingestion of cylindrical and button batteries: An analysis of 2382 cases. Pediatrics 1992;89(4 Pt 2):747-57.  Back to cited text no. 5
    
6.
Singh A, Bajpai M, Panda SS, Chand K, Jana M, Ali A. Oesophageal foreign body in children: 15 years experience in a tertiary care paediatric centre. Afr J Paediatr Surg 2014;11:238-41.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Fuentes S, Cano I, Benavent MI, Gómez A. Severe esophageal injuries caused by accidental button battery ingestion in children. J Emerg Trauma Shock 2014;7:316-21.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Alam E, Mourad M, Akel S, Hadi U. A case of battery ingestion in a pediatric patient: What is its importance? Case Rep Pediatr 2015;2015:345050.  Back to cited text no. 8
    
9.
Uyemura MC. Foreign body ingestion in children. Am Fam Physician 2005;72:287-91.  Back to cited text no. 9
    
10.
Martínez-Criado Y, Millán López A, Valladares JC, De Agustín Asensio JC. Esophageal impaction of button batteries in childhood. How to avoid tragedy! Cir Pediatr 2013;26:142-5.  Back to cited text no. 10
    
11.
Fakhim SA, Bayazian G, Sohrabpour M. Neglected esophageal button battery ingestion. Local protocol for management. Egypt J Ear Nose Throat Allied Sci 2013;14:27-31.  Back to cited text no. 11
    
12.
Samad L, Ali M, Ramzi H. Button battery ingestion: Hazards of esophageal impaction. J Pediatr Surg 1999;34:1527-31.  Back to cited text no. 12
    

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Correspondence Address:
Abdulfatai B Olokoba
Department of Medicine, Division of Gastroenterology, University of Ilorin Teaching Hospital, Ilorin
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.181706

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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