2 AORTO-OESOPHAGEAL FISTULAS AND BUTTON BATTERIES - A CASE SERIES
Joana Lopes, Natasha Khan, Philip Botha, Oliver Gee
Birmingham Children's Hospital, Birmingham, United Kingdom

Abstract


Aim of the study

Button Batteries (BBs) are now in widespread use and have become commonplace in many household items, including those intended for children. The serious risks for a child swallowing a BB are not often clear to parents or carers.  We report a series of toddlers presenting with life-threatening haematemesis secondary to an aorto-oesophageal fistula (AOF). We describe our techniques and share our learning from these catastrophic injuries.

Methods

A case series review of successive patients presenting with significant haematemesis secondary to AOF.


Main Results

Over a 3 year period, 3 patients (2M,1F), aged 2-3 years old, presented with life-threatening haematemesis from an AOF.  At the time of initial presentation no patient had a known contact with, or ingestion of, a BB.  1 patient died before transfer to our centre (AOF identified at post-mortem).  1 patient still had the BB within the oesophagus.  1 patient had endoscopic retrieval of a BB 3 weeks prior to presenting with haematemesis.  This battery had only been identified after repeated hospital attendances due to parental concerns over perceived breathing and eating difficulties.  CT Angiography demonstrated both AOF, although the retained BB initially hindered identification.  Both patients underwent oesophageal and aortic repair (1 graft, 1 patch), 1 required cardiac bypass.  A Sengstaken-Blakemore tube was used to temporise one patient. Both surviving patients are at home eating normally.  1 patient required oesophageal stricture dilatation.


Conclusion

BB ingestion is becoming more common and toddlers will often present with secondary symptoms without a history of ingestion.  Only one patient has previously been reported in the literature as surviving from AOF following BB ingestion.  It is of vital importance that clinicians are highly suspicious of the possibility of BB ingestion in children presenting with catastrophic haematemesis. With timely diagnosis and intervention a successful outcome is possible.


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