PDF(Pubmed)
Abstract：
BACKGROUND: Button battery (BB) ingestions (BBI) are increasingly prevalent in children and constitute a significant, potentially life-threatening health hazard, and thus a pediatric emergency. Ingested BBs are usually charged and can cause severe symptom within 2 h. Discharged BBs ingestion is very rare and protracted symptom trajectories complicate diagnosis. Timely imaging is all the more important. Discharged BBs pose specific hazards, such as impaction, and necessitate additional interventions.
METHODS: We present the case of a previously healthy 19-month-old girl who was admitted to our pediatric university clinic in Germany for assessment of a three-month history of intermittent, mainly inspiratory stridor, snoring and feeding problems (swallowing, crying at the sight of food). The child\'s physical examination and vital signs were normal. Common infectious causes, such as bronchitis, were ruled out by normal lab results including normal infection parameters, negative serology for common respiratory viruses, and normal blood gas analysis, the absence of fever or pathological auscultation findings. The patient\'s history contained no evidence of an ingestion or aspiration event, no other red flags (e.g., traveling, contact to TBC). Considering this and with bronchoscopy being the gold standard for foreign body (FB) detection, an x-ray was initially deferred. A diagnostic bronchoscopy, performed to check for airway pathologies, revealed normal mucosal and anatomic findings, but a non-pulsatile bulge in the trachea. Subsequent esophagoscopy showed an undefined FB, lodged in the upper third of the otherwise intact esophagus. The FB was identified as a BB by a chest X-ray. Retrieval of the battery proved extremely difficult due to its wedged position and prolonged ingestion and required a two-stage procedure with consultation of Ear Nose Throat colleagues. Recurring stenosis and regurgitation required one-time esophageal bougienage during follow-up examinations. Since then, the child has been asymptomatic in the biannual endoscopic controls and is thriving satisfactorily.
CONCLUSIONS: This case describes the rare and unusual case of a long-term ingested, discharged BB. It underscores the need for heightened vigilance among healthcare providers regarding the potential hazards posed by discharged BBIs in otherwise healthy children with newly, unexplained stridor and feeding problems. This case emphasizes the critical role of early diagnostic imaging and interdisciplinary interventions in ensuring timely management and preventing long-term complications associated even to discharged BBs.
METHODS: We present the case of a previously healthy 19-month-old girl who was admitted to our pediatric university clinic in Germany for assessment of a three-month history of intermittent, mainly inspiratory stridor, snoring and feeding problems (swallowing, crying at the sight of food). The child\'s physical examination and vital signs were normal. Common infectious causes, such as bronchitis, were ruled out by normal lab results including normal infection parameters, negative serology for common respiratory viruses, and normal blood gas analysis, the absence of fever or pathological auscultation findings. The patient\'s history contained no evidence of an ingestion or aspiration event, no other red flags (e.g., traveling, contact to TBC). Considering this and with bronchoscopy being the gold standard for foreign body (FB) detection, an x-ray was initially deferred. A diagnostic bronchoscopy, performed to check for airway pathologies, revealed normal mucosal and anatomic findings, but a non-pulsatile bulge in the trachea. Subsequent esophagoscopy showed an undefined FB, lodged in the upper third of the otherwise intact esophagus. The FB was identified as a BB by a chest X-ray. Retrieval of the battery proved extremely difficult due to its wedged position and prolonged ingestion and required a two-stage procedure with consultation of Ear Nose Throat colleagues. Recurring stenosis and regurgitation required one-time esophageal bougienage during follow-up examinations. Since then, the child has been asymptomatic in the biannual endoscopic controls and is thriving satisfactorily.
CONCLUSIONS: This case describes the rare and unusual case of a long-term ingested, discharged BB. It underscores the need for heightened vigilance among healthcare providers regarding the potential hazards posed by discharged BBIs in otherwise healthy children with newly, unexplained stridor and feeding problems. This case emphasizes the critical role of early diagnostic imaging and interdisciplinary interventions in ensuring timely management and preventing long-term complications associated even to discharged BBs.
摘要：
背景：纽扣电池（BB）摄入（BBI）在儿童中越来越普遍，潜在的威胁生命的健康危害，因此是儿科急症.摄入的BBs通常是带电的，可在2小时内引起严重症状。排出的BBs摄入非常罕见，长期的症状轨迹使诊断复杂化。及时成像更为重要。排放的BB会造成特定的危险，比如撞击，并需要额外的干预措施。
方法：我们介绍了一个以前健康的19个月女孩的案例，该女孩被我们在德国的儿科大学诊所收治，以评估三个月的间歇性病史，主要是吸气喘鸣，打鼾和进食问题(吞咽，一看到食物就哭)。患儿体格检查及生命体征正常。常见的感染原因,比如支气管炎，被包括正常感染参数在内的正常实验室结果排除，常见呼吸道病毒的血清学阴性，和正常的血气分析,没有发烧或病理性听诊结果。患者的病史没有摄入或误吸事件的证据，没有其他危险信号(例如，旅行,联系TBC）。考虑到这一点，并且支气管镜检查是异物（FB）检测的金标准，X射线最初被推迟.诊断支气管镜检查，检查气道病变，显示正常的粘膜和解剖结果，而是气管中的非脉动凸起。随后的食管镜检查显示不确定的FB，留在原本完整的食道的上三分之一处。通过胸部X射线将FB鉴定为BB。由于电池的楔入位置和长时间的摄入，取回电池非常困难，并且需要在耳鼻喉同事的咨询下进行两阶段的程序。在随访检查期间，复发性狭窄和反流需要一次性食管结扎。从那以后,该儿童在一年两次的内窥镜控制中无症状，并且正在令人满意地成长。
结论：此案例描述了长期摄入的罕见和不寻常的情况，出院的BB。它强调了医疗保健提供者需要提高对出院BBI对其他健康儿童的潜在危害的警惕，无法解释的喘鸣和喂养问题。该病例强调了早期诊断成像和跨学科干预在确保及时处理和预防甚至与出院BB相关的长期并发症方面的关键作用。
方法：我们介绍了一个以前健康的19个月女孩的案例，该女孩被我们在德国的儿科大学诊所收治，以评估三个月的间歇性病史，主要是吸气喘鸣，打鼾和进食问题(吞咽，一看到食物就哭)。患儿体格检查及生命体征正常。常见的感染原因,比如支气管炎，被包括正常感染参数在内的正常实验室结果排除，常见呼吸道病毒的血清学阴性，和正常的血气分析,没有发烧或病理性听诊结果。患者的病史没有摄入或误吸事件的证据，没有其他危险信号(例如，旅行,联系TBC）。考虑到这一点，并且支气管镜检查是异物（FB）检测的金标准，X射线最初被推迟.诊断支气管镜检查，检查气道病变，显示正常的粘膜和解剖结果，而是气管中的非脉动凸起。随后的食管镜检查显示不确定的FB，留在原本完整的食道的上三分之一处。通过胸部X射线将FB鉴定为BB。由于电池的楔入位置和长时间的摄入，取回电池非常困难，并且需要在耳鼻喉同事的咨询下进行两阶段的程序。在随访检查期间，复发性狭窄和反流需要一次性食管结扎。从那以后,该儿童在一年两次的内窥镜控制中无症状，并且正在令人满意地成长。
结论：此案例描述了长期摄入的罕见和不寻常的情况，出院的BB。它强调了医疗保健提供者需要提高对出院BBI对其他健康儿童的潜在危害的警惕，无法解释的喘鸣和喂养问题。该病例强调了早期诊断成像和跨学科干预在确保及时处理和预防甚至与出院BB相关的长期并发症方面的关键作用。
