Pediatric emergency medicine trisk 0679 0679
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (101.79 KB, 1 trang )
objects, such as a quarter, may remain in the stomach for a long duration. In these
cases, a prolonged time (up to a few weeks) can be allowed for passage of inert
objects out of the stomach before surgical or endoscopic removal is necessary. If
the patient with an ingested foreign body becomes symptomatic, endoscopic or
surgical intervention may be necessary.
Button Battery Ingestion
Button batteries are the power source for many household items, including
watches, car remotes, cameras, calculators, and hearing aids, frequently putting
them within reach of children. From 1985 to 2009, there was a 6.7-fold increase
in the percentage of button battery ingestions with major or fatal outcomes,
according to the National Poison Data System. This is due to the emergence of
the 20-mm lithium cell as a popular household battery, which is responsible for
92.1% of serious or fatal ingestions. All fatalities and most major morbidities
occur in children younger than 4 years of age. Button batteries with other cell
chemistries (manganese dioxide, zinc-air, silver oxide, and mercuric oxide) have
not been associated with significant injuries or death. The mechanisms of injury
include direct pressure necrosis, generation of an external electrolytic current
resulting in liquefaction necrosis, and leakage of material causing direct caustic
injury. Button batteries in the esophagus should be identified and removed
emergently, ideally within 2 hours of ingestion. Care should be taken when
evaluating a disc-shaped foreign object on radiograph, as ingested button batteries
may be mistaken for a coin. Findings that suggest a button battery are the “double
rim” or “halo” effect on an AP radiograph, or a step-off pattern on a lateral chest
radiograph ( Fig. 32.5 ). Button batteries in the stomach or beyond of an
asymptomatic patient should be left to pass spontaneously if the battery is <20
mm in diameter or the patient is ≥5 years of age. Parents should be advised to
inspect the stool for the battery, and a radiograph should be repeated in 2 days
(for ≥20-mm batteries) or 10 to 14 days (for <20-mm batteries) if the battery has
not yet passed. Endoscopic removal is needed if the battery has not passed the
stomach in that time, or if the patient becomes symptomatic. For young patients
(<5 years old) with a large battery (≥20 mm) in the stomach, assessment for
esophageal injury and endoscopic removal of the battery within 24 to 48 hours
should be considered. If an esophageal injury is present, further evaluation for
complications with CT angiography and/or MRI may be warranted.
Complications after removal of the battery include tracheoesophageal fistula,
esophageal stricture or perforation, mediastinitis, and vocal cord paralysis. The
most common cause of death is secondary to an aortoesophageal fistula. Only
