Hemorrhagic shock secondary to button battery ingestion

CONTEXT:Button battery ingestion is a frequent pediatric complaint. The serious complications resulting from accidental ingestion have increased significantly over the last two decades due to easy access to gadgets and electronic toys. Over recent years, the increasing use of lithium batteries of diameter 20 mm has brought new challenges, because these are more detrimental to the mucosa, compared with other types, with high morbidity and mortality. The clinical complaints, which are often nonspecific, may lead to delayed diagnosis, thereby increasing the risk of severe complications.CASE REPORT:A five-year-old boy who had been complaining of abdominal pain for ten days, was brought to the emergency service with a clinical condition of hematemesis that started two hours earlier. On admission, he presented pallor, tachycardia and hypotension. A plain abdominal x-ray produced an image suggestive of a button battery. Digestive endoscopy showed a deep ulcerated lesion in the esophagus without active bleeding. After this procedure, the patient presented profuse hematemesis and severe hypotension, followed by cardiorespiratory arrest, which was reversed. He then underwent emergency exploratory laparotomy and presented a new episode of cardiorespiratory arrest, which he did not survive. The battery was removed through rectal exploration.CONCLUSION:This case describes a fatal evolution of button battery ingestion with late diagnosis and severe associated injury of the digestive mucosa. A high level of clinical suspicion is essential for preventing this evolution. Preventive strategies are required, as well as health education, with warnings to parents, caregivers and healthcare professionals.

背景：纽扣电池摄入是儿科常见的急诊主诉。近二十年来，随着各类小器具与电子玩具的普及程度提升，意外摄入纽扣电池引发的严重并发症发生率显著上升。近年来，直径20mm的锂电池使用量持续增加，带来了新的诊疗挑战：相较于其他类型的纽扣电池，该类电池对消化道黏膜的损伤更为严重，可导致极高的发病率与死亡率。由于此类摄入的临床症状往往缺乏特异性，易造成诊断延迟，进而大幅提升严重并发症的发生风险。
病例报告：一名因腹痛持续10天、并于2小时前出现呕血而就诊的5岁男童被送至急诊。入院时，患儿表现为面色苍白、心动过速及低血压。腹部平片影像提示存在纽扣电池。消化内镜检查显示食管存在深溃疡性病变，未见活动性出血。内镜操作完成后，患儿出现大量呕血与严重低血压，随后发生心搏呼吸骤停，经抢救恢复循环。随后患儿接受急诊剖腹探查术，术中再次出现心搏呼吸骤停，最终不治身亡。术中经直肠探查取出了该纽扣电池。
结论：本病例报告了一例因诊断延迟、消化道黏膜严重损伤而导致死亡的纽扣电池摄入病例。临床需保持高度的诊疗警惕以避免此类不良预后。亟需制定针对性预防策略，并开展健康教育，向家长、照护者及医护人员传递相关警示信息。