Button battery in esophagus of a 20-month old boy for 3 weeks without any complication

Foreign body ingestion in children is common and most children are observed to be between 6 months and 3 years of age. Esophageal button batteries require emergency removal regardless of the presence of symptoms because they can cause serious complications. The complications are related to mechanical, electrical and chemical effects. The incidence of button battery ingestion has not significantly changed in the past 30 years. However, serious or fatal injury has increased 6.7-fold since the 1980s. Severe injuries include esophageal perforation, tracheoesophageal fistula, major vessel fistula, and vocal fold paralysis. So, the time is very important to diagnosis and adequate management of patients.A 20-month-old previously healthy boy presented to his pediatrician with a progressive coughing, coryza, inspiratory stridor and wheezing from 20 days ago. The symptoms were started suddenly while he was playing with his friend and toys. He was initially treated with antibiotics; but after he developed signs a chest radiograph was obtained that showed a round radiopaque 25-mm foreign body in the proximal esophagus concerning for button battery. He had transferred to operating room for endoscopy. The patient was intubated with a 4.0 cuffless endotracheal tube. On rigid esophagoscopic removal of the battery there were severe edema and grey exudate of the upper esophagus. The procedure was unsuccessful to remove of foreign body because of the dense adhesion of battery to the esophageal mucosa. Subsequently, it was pushed done to thestomach. Then the patient was transport to ward and made to take nothing by mouth and placed on intravenous antibiotics.On hospital day two, an esophagogram showed no evidence of perforation and battery was presented in the stomach. Therefore, he was advanced to a clear liquid diet and was discharged home on hospital day 4.In the follow up visit within one month after discharge he had no difficulties with oral intake. In conclusion, Button battery impaction in the esophagus can rapidly cause serious injury to the esophagus and surrounding structures, including the recurrent laryngeal nerves leading to vocal cord paralysis. This specific complication should be considered in any child with persistent stridor or respiratory distress