title: An unusual case of button battery-induced traumatic tracheoesophageal fistula.
abstract: BACKGROUND
  Much of pediatric medicine is focused on prevention of disease and injury. Although accidental ingestions of various household chemicals and medicines are well described and the treatment is supported by local poison control hotlines, the ingestion of button batteries by children is less publicized, and the dangers are less understood by both parents and health care providers.
  
  
  METHODS
  We describe a case report of a 17-month-old girl with no significant medical history who presented with respiratory distress, cough, and fever and subsequently was discovered to have ingested a button battery.
  
  
  RESULTS
  The formation of a traumatic tracheoesophageal fistula required intensive management that escalated to cardiopulmonary bypass and eventual pericardial patch closure of the tracheal defect after the failure of conventional mechanical ventilation.
  
  
  CONCLUSIONS
  Esophageal button battery impaction places the patient at high risk for full-thickness damage to the esophagus and tracheal structures with fistula formation in as little as a few hours. The key to successful therapy is prompt diagnosis and removal, but in nonverbal pediatric patients, this often is not achievable. Because of the complications associated with this disease (tracheoesophageal fistula) and subsequent difficulties associated with oxygenation and ventilation, these patients should be managed at an institution with the skilled capability of providing cardiopulmonary bypass quickly as a potentially lifesaving therapy.
authors.affiliation: Department of Anesthesia and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA. nslamon@nemours.org
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Slamon
authors.forename: James H
authors.initials: JH
authors.lastname: Hertzog
authors.forename: Scott H
authors.initials: SH
authors.lastname: Penfil
authors.forename: Russell C
authors.initials: RC
authors.lastname: Raphaely
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Derby
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005549:Foreign-Body Reaction; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D014138:Tracheoesophageal Fistula / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery