title: Delayed presentation of button battery ingestion: a devastating complication.
abstract: A 12-month-old child presented with a prolonged history of fever, cough and difficulty breathing, which was initially treated as bronchiolitis. She was discharged but presented again to Accident and Emergency department 4 days later with worsening symptom. Following deterioration in the Emergency department, a chest X-ray revealed a button battery in the upper oesophagus. Emergency oesophagoscopy was performed where a 20 mm button battery was removed and a tracheoesophageal fistula was seen 12 mm above the carina. Near total oesophagectomy, cervical oesophagostomy and gastrostomy were performed with a patch repair of the trachea, followed by a bioabsorbable tracheal stent. The patient spent a prolonged period of time in intensive care and was treated with intravenous antibiotics for mediastinitis. This case highlights the difficulty in diagnosis of button batteries when there is no clear history and the devastating consequences of prolonged exposure.
authors.affiliation: Department of ENT, St George's Hospital London, London, UK.
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-7252-1660
authors.initials: R
authors.lastname: Chessman
authors.affiliation: University College London Ear Institute, London, UK misha.verkerk.09@ucl.ac.uk.
authors.forename: Misha
authors.initials: M
authors.lastname: Verkerk
authors.affiliation: ENT Head and Neck Surgery, Great Ormond Street Hospital For Children NHS Trust, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Hewitt
authors.affiliation: Department of ENT, St George's Hospital London, London, UK.
authors.forename: Nneka
authors.initials: N
authors.lastname: Eze
mesh_terms: D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging*; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D007223:Infant; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery*
keywords: Gastroenterology; Oesophagus; Otolaryngology