MANAGEMENT OF FOREIGN BODY

‘BUTTON CELL BATTERY’ WITH

ESOPHAGOSCOPY IN 14 MONTH OLD BOY

Aditiya Yuda P A Simbolon, Linda I Adenin

 1.

Introduction
Introduction

✘ Foreign body ingestion is common in children

✘ Most foreign body ingestion occur in children between 6 months

and 3 years of age

✘ Often swallow coins, toy parts, jewelry or batteries

 Introduction
Between 2000 – 2009
More than 90% of serious outcomes from
button cell battery in children

United States`

In 2009
Nearly 6000 US
Children came to
emergency
department for
button cell
battery Some of these children have permanently
exposures. damage to their esophagus
Introduction

✘ Battery ingestion is potentially life threathening

✘ Battery entrapped in digestive tract leading to caustic injury

✘ Coagulative necrosis process start within 15 minutes of contact

Introduction

✘ Emergent removal sould performed in sympatomatic patients

✘ In asymptomatic patients can be postpone for 12 to 24 hours

except:

✘ The foreign object is sharp and/or has potential to perforate the

esophagus
 2.

Case Report
Case Report

a 14-month-old boy presented to Adam Malik General Hospital on

February 6th 2018 with main complaint vomitting and sputtering while eating

• Subfebrile Fever (+)

• Chocking ( - ) Chest Radiograph : Blood Laboratory :
• Dispnoe ( - )
There was a metal Leukosit : 22.820 / μl
• Stridor ( - ) foreign body as high as
• Retraction ( - ) vertebra cervicalis 5 – 7
• Cyanosis ( - )
Case Report

Antero-posterior and lateral chest x-ray in RS HAM 6/2/2018

Case Report

The operation was done on February 7th 2018

✘ Patient was anasthesized with ETT and IVFD well attached, then
the operation area was desinfected using bethadine and alcohol
70%,
✘ Patient on supine position with shoulder in the edge of the table

✘ insert the esophagoscope carefully in vertical position through the

oropharyng. Slowly lifted his head and evaluate valecula,
epiglottic, pharyngo-epiglottica plica and laryng.
Case Report

✘ Passing through the cricopharyngeal, move the esophagoscope to

suprasternal fossa and found the crescent shape lumen and
entering the lumen
✘ We saw the silver metal in cricopharyngeal area
✘ We inserted the right pliers (cunam) into the esophagoscope and
clipped the button cell battery thightly
✘ Then pulled out simultaneously the esophagoscope and the pliers
✘ The button cell battery pulled out succesfully
Case Report

✘ evaluate the esophagus to reassure there were not any laceration

or abnormality.
✘ Post operation, we inserted nasogastric tube and evaluate for 3
days

After the surgery :

✘ patient was given antibiotic, analgetic and diet via nasogastric tube
✘ We planned to use the nasogastric tube for three days but on
second day the patient discharges againts medical advice
Case Report
 3.

Discussion
Discussion

• Most foreign body ingestion occur in children

Lee et al, 2016 between 6 months and 3 years of age. Children
often swallow coins, toy parts, jewelry or batteries

In this case our patient was 14 month old and the ingested foreign
body was a button cell battery.
Discussion

• The ingestion is often unwitnessed especially in

toddlers. Fevers, wheezing, ronchi, stridor,
Wallace et al, 2016
drooling, or vomitting suggest the presence of an
esophageal foreign body

In this case our patient complain was dificullty swallowing, vomiting

and subfebrile fever
Discussion

• A lateral soft tissue radiograph of neck and chest

radiograph may show a radio-opaque foreign body,
Chevretton, 2008
widening or the presence of a air bubble at the
postcricoid space or subcutaneous emphysema

In our patient we found no drooling of saliva, there weren’t an

subcutaneous emphysema in neck area. Chest radiograph showed
radio-opaque foreign body
Discussion

• In the Unites States and Europe, approximately

Yunker dan Friedman, 60% to 70% of foreign body become lodged at the
2014 upper esophageal sphincter or cricopharyngeus
muscle.

In this case the foreign body was lodged at upper esophageal

sphincter or cricopharyngeus muscle which was the most common
lodged area
Discussion

Shinhar, Strabbing dan • The decisions whether rigid esophagoscopy should be performed when
dealing with the pediatric population is always challenging. But we must
Madgy, 2003 keep in mind that rigid esophagoscopy is a relative safe procedure

• Endoscopy under general anesthesia with a protected airway is the

mainstay of esophageal foreign body management with esophagoscopy
Yunker dan Friedman, 2014 is not without risk, including pharyngeal bleeding, accidental extubation,
hypoxia, esophageal perforation, and mediastinitis

The procedure we performed was rigid esophagoscopy under general

anesthesia and there weren’t any complication post operation