Three-year-old girl rescued with innovative intervention at IRCCS ISMETT

The girl is the first to survive an aortoesophageal fistula caused by button battery ingestion.

The baby had accidentally swallowed a button battery that had caused an aortoesophageal fistula. She was saved thanks to a multidisciplinary approach that involved a minimally-invasive endoscopy and an interventional cardiology procedure.  The state-of-the-art intervention on the 3-year-old girl was performed at IRCCS ISMETT. The case was recently published on the Journal of Medical Case Reports (journal of the prestigious Nature network).

The 3-year-old girl presented to the emergency room of Children’s Hospital in Palermo complaining of abdominal pain.  An abdominal X-ray showed a coin lithium battery located in the fundus of her stomach.  In the following hours she developed massive hematemesis and severe hypovolemic shock that could not be controlled even after surgical intervention. The hospital’s pediatric surgeons decided to refer the child to IRCCS ISMETT.

The battery had caused thoracic aortic rupture and an aortoesophageal fistula, followed by massive bleeding.  Given her extremely critical conditions, an innovative approach was attempted:    a multidisciplinary team of endoscopists, interventional cardiologists, anesthesiologists, radiologists, pediatric surgeons, thoracic surgeons, and pediatricians was assembled with very short notice.   In conditions of extreme emergency, while maintaining her vital functions, the bleeding was temporarily stopped endoscopically inflating a dilation balloon in the esophagus.   Under radiological guidance and with a percutaneous access, the interventional cardiology team was able to position a covered prosthesis that was released inside the aorta across the rupture, and definitively stopping the bleeding.  The child’s conditions improved immediately and, after a few days in the ICU, she could gradually resume eating. Currently, the child’s conditions are good, she goes to school, and lives a normal life.

To date, 239 cases of extremely serious complications following battery ingestion and 59 cases of pediatric deaths have been reported by the U.S. National Capital Poison Center (NCPC). Given the increased number of electronic devices in our homes (these batteries are used for a wide range of electronic devices, especially toys, watches, video games, remote controllers), the incidents are significantly increasing. The Italian Ministry of Health and specialists in this industry are warning on the hazards caused by these batteries.  Button batteries are in fact the most dangerous because of their small volume and widespread use.

Button battery ingestion is almost always lethal for children.  These batteries have a very strong electric charge: if they get stuck in the esophagus they can activate and end up corroding the esophageal walls like a caustic substance.  The most serious adverse event is aortoesophageal fistula. The child treated at ISMETT with the minimally-invasive technique is the first to survive an aortoesophageal fistula caused by ingestion of a button battery.  Only in one other case did a child survive, but after several destructive surgical attempts.

“Prevention must be the primary goal,” commented Dr. Antonino Granata, an endoscopist at ISMETT. “This social emergency must be addressed by manufacturers of electronic products, who must highlight the risk of ingestion on the packages.  Particular attention must be paid to purchasing only products with CE marking, provided with safety mechanisms to prevent children from opening them”.

“The procedure performed at ISMETT is a concrete example of the importance of a multidisciplinary team,” added Dr. Mario Traina, Director of ISMETT’s Endoscopy Unit.  “We were able to rescue our small patient thanks to our know-how and our advanced technologies, but mainly thanks to a teamwork involving several professionals, from interventional cardiologists to pediatricians, from surgeons to endoscopists.  I would like to highlight the work of our interventional cardiology team led by Dr. Caterina Gandolfo and of all the professionals from Children’s Hospital in Palermo who worked in extremely difficult conditions, in a genuine spirit of cooperation,” concluded Dr. Traina.