Chronic stridor in a toddler after ingestion of a discharged button battery: a case report

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...

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Main Authors: Zoe S. Oftring, Doortje M. Mehrtens, Julian Mollin, Eckard Hamelmann, Sebastian Gaus
Format: Article
Language:English
Published: BMC 2024-04-01
Series:BMC Pediatrics
Subjects:
Online Access:https://doi.org/10.1186/s12887-024-04730-1
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author Zoe S. Oftring
Doortje M. Mehrtens
Julian Mollin
Eckard Hamelmann
Sebastian Gaus
author_facet Zoe S. Oftring
Doortje M. Mehrtens
Julian Mollin
Eckard Hamelmann
Sebastian Gaus
author_sort Zoe S. Oftring
collection DOAJ
description 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. Case presentation 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. Conclusion 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.
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spelling doaj.art-057e86a93e1346d3b8180a5d6148b41f2024-04-07T11:31:18ZengBMCBMC Pediatrics1471-24312024-04-012411710.1186/s12887-024-04730-1Chronic stridor in a toddler after ingestion of a discharged button battery: a case reportZoe S. Oftring0Doortje M. Mehrtens1Julian Mollin2Eckard Hamelmann3Sebastian Gaus4Department of Paediatrics, University Clinic Giessen & MarburgDepartment of Paediatrics, Bielefeld University, University Hospital OWL, Children’s Center BethelDepartment of Paediatrics, Bielefeld University, University Hospital OWL, Children’s Center BethelDepartment of Paediatrics, Bielefeld University, University Hospital OWL, Children’s Center BethelPediatric Emergency Department, Bielefeld University, University Hospital OWL, Children’s Center BethelAbstract 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. Case presentation 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. Conclusion 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.https://doi.org/10.1186/s12887-024-04730-1OtolaryngologyPediatricsForeign bodyButton batteryCase report
spellingShingle Zoe S. Oftring
Doortje M. Mehrtens
Julian Mollin
Eckard Hamelmann
Sebastian Gaus
Chronic stridor in a toddler after ingestion of a discharged button battery: a case report
BMC Pediatrics
Otolaryngology
Pediatrics
Foreign body
Button battery
Case report
title Chronic stridor in a toddler after ingestion of a discharged button battery: a case report
title_full Chronic stridor in a toddler after ingestion of a discharged button battery: a case report
title_fullStr Chronic stridor in a toddler after ingestion of a discharged button battery: a case report
title_full_unstemmed Chronic stridor in a toddler after ingestion of a discharged button battery: a case report
title_short Chronic stridor in a toddler after ingestion of a discharged button battery: a case report
title_sort chronic stridor in a toddler after ingestion of a discharged button battery a case report
topic Otolaryngology
Pediatrics
Foreign body
Button battery
Case report
url https://doi.org/10.1186/s12887-024-04730-1
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