2-Year-Old Boy Developed an Aortoesophageal Fistula After Swallowing a Button Battery

Aortoesophageal Fistula
Endoscpic view of esophageal injury before (A) (shows circumferential exudate and battery in place) and after (B) removal of button battery (shows circumferential deep ulceration, necrosis, and hemorrhage).

Aortoesophageal fistula after ingestion of a button battery

Cases of infants or children accidentally swallowing button batteries are quite common. This often poses a surgical emergency and may have a fatal outcome. Likewise, in a similar case, a 2-year-old developed an aortoesophageal fistula (AEF), after he swallowed a button battery.

The patient presented with hematemesis, 9 days after ingesting a button battery. Although the battery was successfully removed endoscopically 16 hours after the incident, the patient was aggressively resuscitated. In this rare case, the toddler developed an AEF. An aortoesophageal fistula is a rare, however, fatal disorder that causes gastrointestinal bleeding. In this condition, abnormal communication forms between the oesophagus and aorta. This may be because of a thoracic aortic aneurysm, foreign body ingestion, postoperative complications or esophageal malignancy.

Investigations and diagnosis

The diagnosis is confirmed using computed tomography angiography or using aortography. The patient’s aorta was successfully repaired using a vascular plug device. And was scheduled for a surgical procedure for 2 months later. The aorta repair kept the patient safe for 2 months. Similarly, the defect was surgically repaired using direct anastomosis and was completed with a patch of bovine pericardium, including closure of the fistula using stitches. The AEF was treated successfully using a novel vascular plug device. Whereas aortic endovascular stenting and vascular ocular placement are minimally invasive emergency options that can be used till a definitive treatment is provided. These are lifesaving procedures considered as a bridge for definitive repair. Most commonly used surgical options include aortic repair defect and replacement of the diseased segment with a graft.

In cases of foreign body ingestion, button batteries are most commonly ingested. Complications depend on the age of the child, anatomical abnormalities, duration of retention, site of dislodgement and of course, size of the foreign body. Management of AEF includes aggressive resuscitation, control of bleeding, novel use of a vascular plug device and percutaneous endovascular repair.

Source: American Journal of Case Reports

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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