ISPUB.COM The Internet Journal of Otorhinolaryngology Volume 13 Number 2 1 of 6 Esophagopleural Fistula In A 3 Year Old Child Following Disk Battery Ingestion. A Umana, M Offiong, J Kuni, U Akpan, A Adekanye, R Mgbe, A Etiuma, A Ewa Citation A Umana, M Offiong, J Kuni, U Akpan, A Adekanye, R Mgbe, A Etiuma, A Ewa. Esophagopleural Fistula In A 3 Year Old Child Following Disk Battery Ingestion.. The Internet Journal of Otorhinolaryngology. 2010 Volume 13 Number 2. Abstract Disk Battery ingestion is a medical emergency often seen children under the age of 6 years with a peak incidence in the 1 to 3 year old. 2 In most cases ingestion is not witnessed however in some cases especially in the older children, there is a history or suspicion of ingestion of the foreign body by the child or caregiver. Of all dangerous oesophageal FB, disk battery is the most dangerous. Occasionally, referral for endoscopic removal of ingested DB body is delayed because transition through the GIT is expected. Disk Battery ingestion seems to be an emerging pediatric emergency associated with clinically significant outcomes in our region. 7 We report a case of a three year old baby who ingested a disk battery and immediately informed the parents. A chest x-ray taken within 2 hours of ingestion revealed a coin like opacity but was misdiagnosed as a 50Kobo coin. The 50Kobo coin hitherto was the commonest circular metallic foreign body in the esophagus in our region. Referral for endoscopic assessment was delayed because transit through the gastrointestinal tract expected. The child seemed comfortable and asymptomatic but suffered significant injury resulting in esophageal pleural fistula within 4 days of ingestion. Battery type was CR2025 and lodgment was at the gastro esophageal sphincter. The need for early presentation to the hospital, correct diagnosis, undelayed endoscopic evaluation and removal of Disk Battery foreign body is reemphasized. The importance of careful history taking, examination and simple plain radiograph of the neck and chest and abdomen in a seeming comfortable and well child with suspicion of foreign body ingestion is highlighted. A review of relevant literature is also done. INTRODUCTION Disk batteries (DB) are small, coin-shaped batteries used in devices such as remote control for MP3 players, toys, watches, calculators, and hearing aids. 1 They are a commonly ingested by children under 6 years of age with a peak age of 1-3 years. 2 Males and females are equally affected. The incidence of DB ingestion increases with accessibility of batteries to children. Accessibility has increased with the expanding use of DB in household and recreational products. Secured battery sources and safe disposal of spent cell also affect accessibility of DB to children. 1 Most cases of DB ingestion are often not witnessed. Most children remain asymptomatic and pass the battery in their stool within 2-7 days. 3 Batteries localized beyond the esophagus rarely need to be retrieved unless the patient manifests signs or symptoms of GI tract injury ( e.g. abdominal pain, tenderness) or a large- diameter battery fails to pass beyond the pylorus. Battery passage is usually confirmed by daily inspections of all stools or weekly radiographs. Lodgments in the esophagus typically present with irritability, food refusal, dysphagia, and increased salivation. It may present with unproductive cough, stridor and wheezing mimicking lower respiratory tract disease . 4 No physical examination findings are specific for patients who ingest disk batteries. Therefore, the lack of symptoms should not be the indicator to rule out esophageal lodgment. Recent reports of DB ingestion in the developed world show that they are usually are benign. 2 However, many major outcomes have occurred, when the ingestion was either not witnessed or initially misdiagnosed (including being mistaken for a coin) or delayed hospital presentation /endoscopic removal because of lack of awareness. 2, 4 The type of battery, size and quality, whether leak proof or not, and the status of the battery whether new or spent, are also risk factors to major outcome. From 2000-2009, 92% of disk batteries from fatal ingestions or those with major