A 2-Year-Old Boy Who Developed an Aortoesophageal Fistula After Swallowing a Button Battery, Managed Using a Novel Procedure with Vascular Plug Device as a Bridge to Definitive Surgical Repair

• Published in: The American journal of case reports 2021-08, Vol.22, p.e931013-e931013
• Main Authors: Alreheili, Khalid M, Almutairi, Mansour, Alsaadi, Ali, Ahmed, Ghousia, Alhejili, Abdulrahman, AlKhatrawi, Taha
• Format: Article
• Language: English
• Subjects: Aortic Diseases - etiology; Aortic Diseases - surgery; Blood Vessel Prosthesis Implantation; Child, Preschool; Deglutition; Esophageal Fistula - etiology; Esophageal Fistula - surgery; Humans; Male; Vascular Fistula - etiology; Vascular Fistula - surgery
• ISSN: 1941-5923; 1941-5923
• DOI: 10.12659/AJCR.931013

BACKGROUND Button batteries (BBs) can be inhaled or swallowed accidentally, particularly by infants and children, who can present as a surgical emergency with a fatal outcome. This report is of a case of a 2-year-old boy who developed an aortoesophageal fistula (AEF) after swallowing a button battery and was successfully treated using a novel vascular plug device as a bridge to definitive surgical repair. AEF is diagnosed using computed tomography angiography (CTA), after laparotomy, and using aortography. Aortic endovascular stenting and vascular occluder placement is a minimally invasive emergency option until definitive treatment can be provided. The surgical options include repair the aortic defect primarily, or the diseased segment of the aorta is replaced with a graft. CASE REPORT A 2-year-old boy presented with hematemesis 9 days after ingestion of a button battery, which was removed endoscopically 16 hours after the incident. The patient was resuscitated aggressively and diagnosed to have AEF using computed tomography angiography (CTA). The aorta was successfully repaired using a vascular plug device, which kept the patient safe until the definitive surgical treatment was done 2 months later. The defect was repaired with direct anastomosis and completed with a patch of bovine pericardium, as well as closure of the fistula from the esophageal side with stitches. CONCLUSIONS This report presents a rare but previously reported complication of swallowing a button battery, resulting in an aortoesophageal fistula. The aorta was successfully repaired using a vascular plug as a minimally invasive emergency option, which is considered as a lifesaving procedure and a bridge for definitive repair.