The initial evaluation for suspected ingested button battery and the basic treatment for esophageal button battery are essentially the same, regardless of type; however, the size of the ingested battery greatly affects the risk for esophageal impaction, with the combination of larger batteries (especially those with a diameter ≥ 20 mm) and smaller patients resulting in a higher risk of becoming impacted. In addition, lithium batteries generate twice the voltage (3 V) of alkaline batteries and are therefore significantly more likely to cause major injury.
Button batteries that become impacted may cause significant damage via three main mechanisms: local hydrolysis and the action of hydroxide on the mucosa, caustic injury and liquefactive necrosis secondary to the high alkaline pH of the chemicals they contain, and electrical discharge that leads to electrical burns (especially with lithium batteries).[3,10] Button batteries impacted within the esophagus can cause severe injury within 4 hours. Follow-up endoscopy is recommended 2-3 days after the battery is removed in certain settings, such as prolonged time to removal and esophageal mucosal injury.[11,12]
The mainstay of treatment for patients who present with acquired tracheoesophageal fistula is thoracotomy for fistula repair. The patient in this case was taken to the operating room and underwent successful primary repair. The patient did well but had some resultant esophageal stenosis, for which she required endoscopic intervention.
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