• Nicholas B Slamon, James H Hertzog, Scott H Penfil, Russell C Raphaely, Christian Pizarro, and Christopher D Derby.
• Department of Anesthesia and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA. nslamon@nemours.org
• Pediatr Emerg Care. 2008 May 1; 24 (5): 313-6.

BackgroundMuch of pediatric medicine is focused on prevention of disease and injury. Although accidental ingestions of various household chemicals and medicines are well described and the treatment is supported by local poison control hotlines, the ingestion of button batteries by children is less publicized, and the dangers are less understood by both parents and health care providers.MethodsWe describe a case report of a 17-month-old girl with no significant medical history who presented with respiratory distress, cough, and fever and subsequently was discovered to have ingested a button battery.ResultsThe formation of a traumatic tracheoesophageal fistula required intensive management that escalated to cardiopulmonary bypass and eventual pericardial patch closure of the tracheal defect after the failure of conventional mechanical ventilation.ConclusionsEsophageal button battery impaction places the patient at high risk for full-thickness damage to the esophagus and tracheal structures with fistula formation in as little as a few hours. The key to successful therapy is prompt diagnosis and removal, but in nonverbal pediatric patients, this often is not achievable. Because of the complications associated with this disease (tracheoesophageal fistula) and subsequent difficulties associated with oxygenation and ventilation, these patients should be managed at an institution with the skilled capability of providing cardiopulmonary bypass quickly as a potentially lifesaving therapy.

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