Battery Ingestion TEF
Why do disc batteries damage the esophagus? The mechanisms include absorption of toxic substances, electrical injury, pressure necrosis, and caustic injury from leaking battery contents. The size of the battery impacts the risk of esophageal entrapment. Lithium batteries generate twice the voltage (3 V) of alkaline batteries, and are more than twice as likely to cause major injury. The increased use of electronic devices has paralleled the increasing incidence of battery ingestions. Timely and prompt removal is critical.
Recent large series studying the epidemiology demonstrated that children under 6 years swallowed batteries: directly from a product (61.8%), loose (29.8%), or were obtained from battery packaging (8.2%). [http://www.ncbi.nlm.nih.gov/pubmed/20498172]
There is no consensus on the treatment of post disk-battery ingestion TEF, due of course to the rarity of the condition and the variable clinical scenarios. There are reports of spontaneous healing of the fistula after the total rest of esophageal mucosa with nasojejunal or nasogastric tube
feeding have been reported. [http://www.ncbi.nlm.nih.gov/pubmed/11879930] [G. Senthilkumaran, S. Crankson, M. Yousef, Spontaneous closure of acquired tracheo-oesophageal ?stula, J. Laryngol. Otol. 110 (1996) 685—687] Several studies recommend this form of management. [http://www.ncbi.nlm.nih.gov/pubmed/15343469] The duration of esophageal rest is unclear – some have recommended more than 6 weeks of esophageal rest even if the fistula appears closed. [http://www.ncbi.nlm.nih.gov/pubmed/18316130]
Acute primary repair can be associated with a high incidence of stricture, recurrent fistula, breakdown of the repair, recurrent laryngeal nerve injury, and a substantial mortality rate.
In general, acquired nonmalignant TEFs are managed with delayed surgical repair since the risk of recurrent fistula is increased when significant inflammation is still present. This may not be possible with large symptomatic fistulae. An adult series of 27 patients with acquired TEF noted a mortality rate of 10 with simple repair. [J. Marzelle, P. Dartevelle, J. Khalife, A. Rojas-Miranda, A. Chapelier, P. Levasseur, Surgical management of acquired post-intubation tracheo-oesophageal ?stulas: 27 patients, Eur. J. Cardiothorac. Surg. 3 (1989) 499—502, discussion 502—493.]
However, ‘conservative management’ is not risk-free, with a possibility of aspiration and pneumonia, especially with large fistulae, failure of resolution, long hospitalization, or recurrence after confirmed resolution.
When repair is done, in most cases it can be done through the neck. As with congenital TEF, passage of a catheter down the esophagus, through the fistula, and back up the trachea may be helpful in localization.
References:
1. Alkan M, Büyükyavuz I, Dogru D et al: Tracheoesophageal fistula due to disc-battery ingestion. Eur J Pediatr Surg 2004; 14: 274-278.
2. Anand TS, Kumar S, Wadhwa V et al: Rare case of spontaneous closure of tracheo-esophageal fistula secondary to disc battery ingestion. Int. J. Pediatr. Otorhinolaryngol 2002; 63: 57-59.
3. Grisel JJ, Richter GT, Casper KA et al: Acquired tracheoesophageal fistula following disc-battery ingestion: can we watch and wait? Int. J. Pediatr. Otorhinolaryngol 2008; 72: 699-706.
4. Imamoglu M, Cay A, Kosucu P et al: Acquired tracheo-esophageal fistulas caused by button battery lodged in the esophagus. Pediatr. Surg. Int 2004; 20: 292-294.
5. Litovitz T and Schmitz BF: Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics 1992; 89: 747-757.
6. Litovitz T, Whitaker N and Clark L: Preventing battery ingestions: an analysis of 8648 cases. Pediatrics 2010; 125: 1178-1183.
7. Okuyama H, Kubota A, Oue T et al: Primary repair of tracheoesophageal fistula secondary to disc battery ingestion: a case report. J. Pediatr. Surg 2004; 39: 243-244.
8. Senthilkumaran G, Crankson S and Yousef M: Spontaneous closure of acquired tracheo-oesophageal fistula. J Laryngol Otol 1996; 110: 685-687.
9. Van Asperen PP, Seeto I and Cass DT: Acquired tracheo-oesophageal fistula after ingestion of a mercury button-battery. Med. J. Aust 1986; 145: 412-415.
10. Yardeni D, Yardeni H, Coran AG et al: Severe esophageal damage due to button battery ingestion: can it be prevented? Pediatr. Surg. Int 2004; 20: 496-501.
