Atila EROĞLU, Yener AYDIN, Atilla TÜRKYILMAZ, Fatma GENÇ

Çocuklarda özefagusa yabancı cisim kaçması sıklığını artıran etken: Alkalen piller

Amaç: Alkalen pil yutma çocuklarda giderek daha sık görülmektedir. Piller özefagusta takılıp kaldığında ciddi komplikasyonlar ve hatta ölümle sonuçlanabilir. Çalışma planı: Çalışmada, alkalen pil yutan ve rijit özefagoskopi ile müdahale edilen yedi hasta (5 erkek, 2 kız; ort. yaş 4.4; dağılım 1-14) geriye dönük olarak incelendi.Bulgular: Tüm olgular pil yuttuktan sonraki 24 saat içinde kliniğimize başvurdu. Bir olguda ateş ve kusma vardı. Tüm olgularda düz radyografi ile yabancı cismin özofagusta olduğu görüldü. Alkalen pil iki olguda servikal özofagusta, dört olguda torasik özofagusta, bir olguda distal özofagusta idi. Yabancı cisimler genel anestezi altında rijit özofagoskopi ile çıkartıldı. Endoskopik değerlendirmede beş hastada mukozal erozyon saptandı. Herhangi bir komplikasyon gelişmeyen olguların ortalama hastanede yatış süresi üç gündü (dağılım 1-5 gün).Sonuç: Alkalen pil yutulması kalıcı sekel bırakan perforasyon ve mediastinite yol açan koroziv özofajitle sonuçlanabilir. Bu nedenle, bu komplikasyonların gelişimini önlemek için pil acilen rijit endoskopiyle çıkartılmalıdır.

Increasing cause of esophageal foreign body ingestion in children: Alkaline batteries

Background: Ingestion of alkaline batteries occurs at an increasing frequency in children. Those that lodge in the esophagus may cause severe complications and even death. Methods: Seven patients (5 boys, 2 girls; mean age 4.4 years; range 1 to 14 years) who underwent rigid esophagoscopy due to ingestion of an alkaline battery were evaluated.Results: All the patients presented within the first 24 hours of ingestion. One patient had fever and vomiting. Foreign bodies were observed in the esophagus on direct radiograms, being in the cervical esophagus in two cases, thoracic esophagus in four cases, and distal esophagus in one case. The alkaline batteries were removed via rigid esophagoscopy under general anesthesia. Endoscopic examination showed mucosal erosion in five patients. No complications were encountered within a mean hospital stay of three days (range 1 to 5 days).Conclusion: Ingestion of alkaline batteries can result in corrosive esophagitis leading to perforation and mediastinitis. Thus, they should be removed via rigid esophagoscopy without delay to prevent these complications.

PDF

___

1) Litovitz T, Schmitz BF. Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics 1992;89:747-57.
2) Thompson N, Lowe-Ponsford F, Mant TG, Volans GN. Button battery ingestion: a review. Adverse Drug React Acute Poisoning Rev 1990;9:157-80.
3) Sheikh A. Button battery ingestions in children. Pediatr Emerg Care 1993;9:224-9.
4) Arana A, Hauser B, Hachimi-Idrissi S, Vandenplas Y. Management of ingested foreign bodies in childhood and review of the literature. Eur J Pediatr 2001;160:468-72.
5) Suita S, Ohgami H, Nagasaki A, Yakabe S. Management of pediatric patients who have swallowed foreign objects. Am Surg 1989;55:585-90.
6) Yamashlta M, Saito S, Koyama K, Hattori H, Ogata T. Esophageal electrochemical burn by button-type alkaline batteries in dogs. Vet Hum Toxicol 1987;29:226-30.
7) Tanaka J, Yamashita M, Yamashita M, Kajigaya H. Esophageal electrochemical burns due to button type lithium batteries in dogs. Vet Hum Toxicol 1998;40:193-6.
8) Topçu S, Çetin G. Özofagusun yabancı cisimleri. In: Yüksel M, Başoğlu A, editörler. Özofagus hastalıklarının tıbbi ve cerrahi tedavisi. İstanbul: Bilmedya Grup; 2002. s. 71-6.
9) Litovitz TL. Button battery ingestions. A review of 56 cases. JAMA 1983;249:2495-500.
10) Votteler TP, Nash JC, Rutledge JC. The hazard of ingested alkaline disk batteries in children. JAMA 1983;249:2504-6.
11) Blatnik DS, Toohill RJ, Lehman RH. Fatal complication from an alkaline battery foreign body in the esophagus. Ann Otol Rhinol Laryngol 1977;86:611-5.
12) Shabino CL, Feinberg AN. Esophageal perforation secondary to alkaline battery ingestion. JACEP 1979;8:360-3.
13) Litovitz TL. Battery ingestions: product accessibility and clinical course. Pediatrics 1985;75:469-76.
14) Kost KM, Shapiro RS. Button battery ingestion: a case report and review of the literature. J Otolaryngol 1987;16:252-7.
15) Maves MD, Carithers JS, Birck HG. Esophageal burns secondary to disc battery ingestion. Ann Otol Rhinol Laryngol 1984;93:364-9.
16) Kürkçüoğlu İC, Eroğlu A, Tekinbaş C, Karaoğlanoğlu N. Çocuklarda kaza ile alkalin pil alımı. Türk Göğüs Kalp Damar Cer Derg 2003;11:193-4.
17) Willis GA, Ho WC. Perforation of Meckel's diverticulum by an alkaline hearing aid battery. Can Med Assoc J 1982; 126:497-8.
18) Kuhns DW, Dire DJ. Button battery ingestions. Ann Emerg Med 1989;18:293 300.
19) Byrne WJ. Foreign bodies, bezoars, and caustic ingestion. Gastrointest Endosc Clin N Am 1994;4:99-119.
20) McDermott VG, Taylor T, Wyatt JP, MacKenzie S, Hendry GM. Orogastric magnet removal of ingested disc batteries. J Pediatr Surg 1995;30:29-32.
21) Ito Y, Ihara N, Sohma S. Magnetic removal of alkaline batteries from the stomach. J Pediatr Surg 1985;20:250-1.
22) Eroglu A, Kurkcuoglu IC, Karaoglanoglu N, Tekinbas C, Yilmaz O, Basoglu M. Esophageal perforation: the importance of early diagnosis and primary repair. Dis Esophagus 2004;17:91-4.
23) Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002;55:802-6.
24) Votteler TP. Warning: ingested disc batteries. Tex Med J 1981;77:7.