WOFAPS 2025 8th World Congress of Pediatric Surgery

Santiago Correa, Edgar Salamanca

Fundacion Cardioinfantil

Foreign body ingestion is common in children, with button batteries being among the most dangerous. When lodged in the esophagus, severe complications such as strictures, tracheoesophageal fistulae, mediastinitis, aortoesophageal fistulae, and even death can occur.

We report a case of a two-year-old girl referred to our institution one month after ingestion and removal of a button battery from the upper esophagus. She has sialorrhea and was on parenteral nutrition support, with suspected tracheoesophageal fistula. Initial evaluation with bronchoscopy and endoscopy revealed a large tracheoesophageal fistula and esophageal stenosis. Due to her age and clinical condition, a fully covered billiary stent was placed at the esophagus to cover the fistula, along with a gastrostomy for enteral nutritional support.

During the first days after procedure, the patient developed mild upper respiratory symptoms and was diagnosed with COVID-19, which delayed further surgical intervention. Over the following weeks, her symptoms improved; sialorrhea decreased, and respiratory status solved. After four weeks, endoscopy with stent removal showed complete fistula closure, confirmed by contrast esophagogram. Two months later, esophageal dilatation was performed without evidence of fistula recurrence on endoscopy, bronchoscopy, or contrast studies.

Button battery ingestion remains a significant hazard, with severe complications. The use of fully covered esophageal stents can serve as an effective temporary measure to control tracheoesophageal fistula while planning definitive surgical repair. In some cases, spontaneous closure may occur, as observed in this case report.