Management of Button Battery Stricture in 22-Day-Old Neonate

Case Report

A 22-day-old baby girl was admitted to the Emergency Department 18 hours after her 2-year-old aunt pushed a button battery (BB) with a diameter of 12 mm and a thickness of 5 mm into her mouth when the mother was not around (child neglect). There was no history of cough, choking or cyanosis. Clinical examination showed a 3.5-kg baby who was maintaining normal O₂ saturation in room air and had stable vital signs. Examination of all systems was normal. Based on the mother's suspicion, as the battery was missing from a toy, a chest X‐ray was done and showed the BB at the level of T1/T2 ([Fig. 1]).

Fig. 1 X-ray showing button battery at the level of T1/T2.

The patient was admitted to the Pediatric Intensive Care Unit (PICU), but an attempted removal of the battery by flexible endoscopy performed by a gastroenterologist failed. A circumferential burn was seen and the BB was ultimately removed by rigid endoscopy aided by the use of a Foley catheter. Evidence of a small concealed perforation in the esophageal wall was treated conservatively. No tracheoesophageal fistula was noticed on follow-up. Oral intake was started after 7 days following the esophagogram. As the patient tolerated full oral intake well, she was discharged home on ranitidine to be seen in the clinic two weeks later. She missed the appointment, reported to emergency department with dysphagia ([Fig. 2]).

Fig. 2 Nonionic esophagogram showed marked stenosis 1 to 2 mm in width and extending along 2 to 3 mm length resulting in marked dilatation of the proximal esophagus.

Esophagosopy, esophageal dilatation and laparoscopic gastrostomy were done. Frequent programmed elective dilatation with a Savary bougie [4] was started under general anesthesia, every 2 weeks in the first 3 months, every three weeks in the following six months and monthly for the last 3 months. Follow-up showed radiological ([Fig. 3]) and clinical improvement. At the age of 18 months, she tolerates full oral feeds and weighs 12 kg.

Fig. 3  Follow-up nonionic esophagogram showed normal esophageal structure.

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