Management and Outcomes of Button Batteries in the Aerodigestive Tract: A Multi-institutional Study.

Autor: Shaffer AD; Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Jacobs IN; Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Derkay CS; Department of Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, Virginia., Goldstein NA; Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York., Giordano T; Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Ho S; Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York., Kim BJ; Division of Pediatric Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A., Park AH; Division of Pediatric Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A., Simons JP; Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2021 Jan; Vol. 131 (1), pp. E298-E306. Date of Electronic Publication: 2020 Feb 18.
DOI: 10.1002/lary.28568
Abstrakt: Objectives/hypothesis: To describe the clinical presentation, management, and complications associated with button battery impaction in the aerodigestive tract in children.
Study Design: Retrospective case series.
Methods: This multi-institutional study, endorsed by the American Society of Pediatric Otolaryngology research consortium, is a retrospective medical record review, including all children at five tertiary-care institutions presenting with button batteries impacted in the aerodigestive tract between January 2002 and December 2014. Battery type/size, duration and location of impaction, presenting symptoms, treatment, complications, and outcomes were examined.
Results: Eighty-one patients were included (64.2% male), with ingestion witnessed in 20 (24.7%). Median age at presentation was 3 years (range, 1 week-14 years). Median time from diagnosis to removal was 2.5 hours (range, 0.4-72 hours). Locations included the esophagus (n = 48), hypopharynx (n = 1), stomach (n = 6), nasal cavity (n = 22), and ear canal (n = 4). Most common symptoms for esophageal/hypopharyngeal impactions included dysphagia (26.5%), nausea/vomiting (26.5%), drooling (24.5%), cough (18.4%), and fever (18.4%). Most common symptoms for nasal impactions included epistaxis (54.6%), rhinorrhea (40.9%), nasal pain (27.3%), and fever (22.7%). Almost all esophageal impactions were from 3-V (89.5%), 20-mm (81.8%) lithium batteries. Severe esophageal complications included stricture (28.6%), perforation (24.5%), tracheoesophageal fistula formation (8.2%), pneumothorax (4.1%), and bilateral true vocal fold paresis (4.1%). Nasal complications included necrosis (59.1%), septal perforation (27.3%), and saddle nose deformity (4.5%). Duration of impaction correlated with an increased likelihood of persistent symptoms only for nasal batteries (P = .049).
Conclusions: Button batteries in the upper pediatric aerodigestive tract or ear canal should be considered a surgical emergency, requiring urgent removal and careful vigilance for complications.
Level of Evidence: 4 Laryngoscope, 131:E298-E306, 2021.
(© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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