An 8-year-old previously healthy girl presented to the paediatric Emergency Unit with sudden onset of heartburn and upper abdominal pain following the ingestion of a button battery (BB). A chest and abdomen radiograph was rapidly obtained. It showed a round radiopaque 22-mm foreign body in the oesophagus. Just before an emergent endoscopic removal was performed, the girl vomited the battery. She was admitted to the inpatient medical floor, where she was ordered to take nothing by mouth. One day after admission, the esophagogastroduodenoscopy (EGD) revealed deep oesophageal ulcers but no evidence of oesophageal perforation/leak. In line with ESPGHAN/NASPGHAN guidelines for oesophageal BB ingestion, a computed tomography angiography of the chest was then obtained to delineate the location of the lesion and its proximity to the aorta, which was shown not to be injured. Repeat EGD on hospital day 14 revealed mucosal re-epithelisation of the oesophagus without clear stricture or evidence of perforation. The patient was then started on a clear-liquid diet and was then advanced to a mechanical soft diet the following day. She was discharged home on day 18.
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According to their findings, the investigators concluded that early and frequent ingestion of honey at home and sucralfate in clinical facilities during the critical period between BB ingestion and endoscopic removal may reduce injury severity and improve patient outcomes.
• This strategy should apply to all BBs with the same mechanism of action, including lithium, alkaline, and silver oxide.
• recommended caution against use in cases of delayed diagnosis or late-stage ingestions, particularly when there is already cliniContraindications included severe allergy to honey or sucralfate and age younger than one year because of the small risk for infant botulism associated with honey.
cal suspicion of perforation, mediastinitis, or sepsis.
Although this contradicts preoperative nothing per os (by mouth) (NPO) guidelines for most pediatric surgeries to lower the risk for gastric content aspiration under anesthesia, this risk is very low, particularlywith rapid-sequence intubation techniques used in non–NPO-emergent casesThe investigators believed that the greater risks associated with rapidly progressing BB injury outweigh the lesser risks of aspiration-related anesthetic complications.
• Authors: News Author: Diana Phillips; CME Author: Laurie Barclay, MD
RIZZI ANTONIO ANGELO
PEDIATRA luned�, 17 Dicembre 2018, ore 14:05
la pubblicazione dell'articolo in questione sull'utilizzo del miele a domicilio prima dell'arrivo in pronto soccorso è avvenuto in seguito alla redazione del mio articolo e purtroppo non sono riuscito a inserire questa "novità" sulla gestione dell'ingestione di button battery nel mio articolo di recente pubblicazione su Medico e Bambino. La ringrazio per la puntuale segnalazione.
Scuola di Specializzazione in Pediatria, Università di Verona mercoled�, 13 Febbraio 2019, ore 09:28