Hemorrhagic shock secondary to button battery ingestion

Abstract

CONTEXT: Button battery ingestion is a frequent pediatric complaint. The serious complications resulting from accidental ingestion have increased significantly over the last two decades due to easy access to gadgets and electronic toys. Over recent years, the increasing use of lithium batteries of diameter 20 mm has brought new challenges, because these are more detrimental to the mucosa, compared with other types, with high morbidity and mortality. The clinical complaints, which are often nonspecific, may lead to delayed diagnosis, thereby increasing the risk of severe complications. CASE REPORT: A five-year-old boy who had been complaining of abdominal pain for ten days, was brought to the emergency service with a clinical condition of hematemesis that started two hours earlier.On admission, he presented pallor, tachycardia and hypotension. A plain abdominal x-ray produced an image suggestive of a button battery. Digestive endoscopy showed a deep ulcerated lesion in the esophagus without active bleeding. After this procedure, the patient presented profuse hematemesis and severe hypotension, followed by cardiorespiratory arrest, which was reversed. He then underwent emergency exploratory laparotomy and presented a new episode of cardiorespiratory arrest, which he did not survive. The battery was removed through rectal exploration. CONCLUSION: This case describes a fatal evolution of button battery ingestion with late diagnosis and severe associated injury of the digestive mucosa. A high level of clinical suspicion is essential for preventing this evolution. Preventive strategies are required, as well as health education, with warnings to parents, caregivers and healthcare professionals. RESUMO CONTEXTO:A ingestão de bateria em disco é queixa frequente em pediatria. As complicações graves decorrentes de ingestão acidental têm aumentado significativamente nas últimas duas décadas, devido ao fácil acesso aos aparelhos e brinquedos eletrônicos. Nos últimos anos, o aumento do uso de baterias de lítio com diâmetro de 20 mm trouxe novos desafios, por serem mais prejudiciais para a mucosa em comparação com outros tipos, com elevada morbidade e mortalidade. As queixas clínicas, muitas vezes inespecíficas, podem levar ao atraso no diagnóstico, aumentando o risco de complicação grave. RELATO DE CASO: Menino de cinco anos, com queixa de dor abdominal há 10 dias, é trazido ao serviço de emergência com quadro clínico de hematêmese há duas horas. Na admissão, apresentava palidez, taquicardia e hipotensão. Imagem sugestiva de bateria em disco foi visualizada na radiografia simples de abdome. A endoscopia digestiva demonstrou lesão ulcerada profunda no esôfago sem sangramento ativo. Após o procedimento, o paciente apresentou hematêmese profusa e hipotensão grave, seguidos de parada cardiorrespiratória (PCR), revertida. Submetido a laparotomia exploradora de urgência, apresentou novo episódio de PCR, sem reversão. A bateria foi removida por exploração retal. CONCLUSÃO: Este caso descreve a evolução fatal de ingestão da b...

Symptoms associated with button batteries injuries in children: An epidemiological review

“…BB could determine severe tissues' damages due to battery's rupture but, more often, due to the generation of electrolytic current hydrolyzing tissues' fluids and producing hydroxide [6]. This substance could lead to tissues' erosion, conducting to complications such as ulceration, necrosis, perforation, fistula hemorrhage and also death [7][8][9]. About a half of BB injuries collected in the ButtonBatteryDB lead to complications (e.g., ulceration, necrosis, perforations and fistula).…”

“…However, the mechanism most frequently described to be related to BB injuries' complications is represented by the generation of an electronic current from the battery in contact with tissue fluids [6]. This reaction determines the production of a substance, the hydroxide, which is dangerous and could lead to severe complications: necrosis, perforation, fistula, hemorrhage and even death [7][8][9].…”

Severe Acute Toxic Exposures in Children and Adolescents: Case Series

“…25 Impaction of button batteries in esophageal lumen can lead to high morbidity, including lethal outcomes. 26,27 Generally, the most serious exposures occur after the ingestion of batteries ≥2 cm in diameter, such as 2032 lithium batteries, often without a report by caregivers, which can lead to delay in diagnosis and endoscopic removal, as well as in the prognosis of local injury. 26,27 It should be noted that batteries lodged in the esophagus can cause serious injuries in the first two hours of contact with the mucosa.…”

“…26,27 Generally, the most serious exposures occur after the ingestion of batteries ≥2 cm in diameter, such as 2032 lithium batteries, often without a report by caregivers, which can lead to delay in diagnosis and endoscopic removal, as well as in the prognosis of local injury. 26,27 It should be noted that batteries lodged in the esophagus can cause serious injuries in the first two hours of contact with the mucosa. Local damage is basically caused by three mechanisms: direct pressure (pressure necrosis); leakage of the battery's chemical content; and generation of electric current by contact of the battery poles with the esophageal mucosa (electrical burn).…”

“…Local damage is basically caused by three mechanisms: direct pressure (pressure necrosis); leakage of the battery's chemical content; and generation of electric current by contact of the battery poles with the esophageal mucosa (electrical burn). 26,27 We use the PSS for severity classification. It was prepared by the European Association of Poison Centers and Clinical Toxicologists (EAPCCT), together with the International Program on Chemical Safety, of the World Health Organization.…”