A2 Years Old Boy with Recurrent Tracheoesophageal Fistula After Surgical Removal of an Esophageal Button Battery

Patient: Male, 2-year-old Final Diagnosis: Button battery induced tracheoesophageal fistula and recurrence Symptoms: Cough • difficulty in swallowing • irritability • lethargy • vomiting Medication: — Clinical Procedure: Buttery removal with tracheoesophageal fistula closure through cervical incision • exploration with esophagostomy and gastrostomy • recurrent tracheoesophageal fistula repair and esophageal anastomosis through thoracotomy Specialty: Otolaryngology • Pediatrics and Neonatology • Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Among the pediatric population, button batteries ingestion is a significant health risk. The main treatment of ingested esophageal button batteries is urgent endoscopic removal. Missed or delayed diagnosis results in serious complications and outcomes. In the literature, high morbidity and mortality have been described in cases of button battery ingestion. By reporting this case we aim to encourage physicians to raise their suspicion of foreign body ingestion in similar pediatric cases and to review the different management approaches in the case of foreign body-induced tracheoesophageal fistula. CASE REPORT: A 2-year-old boy was referred to us with difficulty in swallowing solids and liquids, with tactile fever for 1 month. A chest X-ray showed a radiopaque foreign body consistent with a button battery. The battery was removed through surgical cervical incision followed by closure of an identified tracheoesophageal fistula, cervical loop esophagostomy, and gastrostomy. After 6 months of follow-up and gastrostomy feeding, recurrence of the tracheoesophageal fistula was identified, for which surgical closure and esophageal anastomosis were performed. A postoperative esophagogram done on day 7 showed no leak or evidence of tracheoesophageal fistula; the patient started oral feeding and the gastrostomy tube was removed. CONCLUSIONS: Even in the absence of witnessed ingestion, the persistent nonspecific symptoms must raise the suspicion of foreign body ingestion in the pediatric age group. Failure of endoscopic removal of the battery is a possibility that need to be included in management algorithms. Surgical repair is the most frequently described approach for foreign body-induced tracheoesophageal fistula repair.