Chessman Robert, Verkerk Misha, Hewitt Richard, Eze Nneka
Department of ENT, St George's Hospital London, London, UK.
University College London Ear Institute, London, UK
BMJ Case Rep. 2017 Apr 6;2017:bcr-2017-219331. doi: 10.1136/bcr-2017-219331.
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.
一名12个月大的儿童出现长期发热、咳嗽和呼吸困难病史，最初被诊断为细支气管炎并接受治疗。她出院了，但4天后因症状加重再次前往急诊科。在急诊科病情恶化后，胸部X线检查显示上食管有一枚纽扣电池。随后进行了急诊食管镜检查，取出了一枚20毫米的纽扣电池，并在隆突上方12毫米处发现了气管食管瘘。实施了近全食管切除术、颈段食管造口术和胃造口术，并对气管进行了修补，随后置入了一个可生物吸收的气管支架。患者在重症监护室接受了长时间治疗，并因纵隔炎接受了静脉抗生素治疗。该病例凸显了在没有明确病史时纽扣电池诊断的困难以及长期接触纽扣电池的灾难性后果。
