[Tracheoesophageal fistula secondary to ingestion of a button battery].

An eleven month old girl was admitted to a county hospital because of persistent low grade fever, cough, vomitus and food and oral fluids rejection. A small radiopaque, button sized, round object was seen impacted in the upper esophageal third on X ray examination and later extracted by endoscopy, corresponding to an electric cell, from a father's handwatch, which had been ingested by the baby without knowledge of parents about 30 h before. After 12 h fasting, oral feedings were resumed being apparently well tolerated, but in the following day fever and respiratory distress reappeared, together with drooling, cianosis, abdominal distention and pale skin. Patient was transferred to a regional hospital where extensive bilateral pneumonia and anemia were documented. Gastric drainage via nasogastric tube, antibiotic treatment, blood transfusion and oxygen therapy were given from admission, but she died within a few hours. At necropsy a 3 per 2.5 cm diameter orifice of sharp borders was seen in the upper third of the esophagus, communicating to tracheal lumen through its upper six cartilages. Extensive, severe, bilateral pneumonia was confirmed. When this kind of electric cells become impacted into the esophagus, wall necrosis may occur within 4 h and perforation within 8 to 12 h and can be prevented by immediate endoscopic extraction. Otherwise fistulae should be suspected and patients managed accordingly. Emergency room medical staff must always be aware of this potentially lethal condition and its proper management. Infants should not be permitted to play with such apparently innocent objects as battery operated handwatches.