Stopping progression of tissue injury after button battery ingestion

September 05, 2019

(COLUMBUS, Ohio) - Button battery injuries in children have been increasingly severe--resulting in devastating injuries and even death. Button batteries damage esophageal tissue through isothermic hydrolysis reactions, resulting in alkaline caustic injury, which leads to tissue necrosis. Prompt removal of the battery is critical to minimizing damage. However, when children swallow a button battery, the injury can progress even after it is removed.

In a recent study from surgeon-researchers at Nationwide Children's Hospital, esophageal irrigation in the operating suite with dilute sterile vinegar, 0.25% acetic acid, after button battery removal was safe and improved mucosal appearance. Household cooking vinegar is typically a 5% concentration.

"Progression of esophageal tissue damage after removal is a hallmark of button battery injury," says Kris Jatana, MD, director of Pediatric Otolaryngology Quality Improvement at Nationwide Children's and lead author of the study publication. "Complications may be delayed up to 9 days for tracheoesophageal fistulas and up to 28 days for aortoesophageal fistulas."

The study, published in The Laryngoscope, followed data from six consecutive patients aged 19 months to 10 years who had a 3V lithium button battery lodged in the esophagus for 2 to 18 hours. Surgeons irrigated the injury site with sterile 0.25% acetic acid after removal.

"When we looked at the tissue in the OR, we could see that it was visually improved after the irrigation," says Dr. Jatana, who is also an associate professor in the Department of Otolaryngology - Head and Neck Surgery at The Ohio State University. "And none of these patients showed immediate or delayed esophageal complications."

The National Capital Poison Center Button Battery Guidelines currently recommends this new irrigation with 0.25% acetic acid during button battery removal. This is the first case series published in pediatric patients, using this initial concept that began at Nationwide Children's. It is now being performed around the world after esophageal button battery removal.

"This study highlights the importance of rapid endoscopic removal and the need for additional strategies to neutralize the injury site. Rapid neutralization of esophageal tissue pH as soon as possible after button battery removal may prevent the continued tissue injury associated with a prolonged alkaline environment and reduce long-term complications," concludes Dr. Jatana, who is also a Co-Chair of the National Button Battery Task Force, affiliated with the American Academy of Pediatrics and American Broncho-Esophagological Association. "This is something that all surgeons can consider to improve outcomes after esophageal button battery injury."
-end-


Nationwide Children's Hospital

Related Irrigation Articles from Brightsurf:

Water consumption for trees is calculated in order to design precision irrigation systems
A University of Cordoba and Spanish National Research Council research team validated an indicator based on using a tree's temperature to calculate relative water consumption at an almond tree plantation

Water-saving alternative forage crops for Texas livestock
With increasing drought conditions in the Texas High Plains, researchers test sorghum and pearl millet as alternatives to corn.

Technology is studied that could save 12% of the energy used in pressurized irrigation
A study, performed in two Andalusian provinces, analyzed the potential of producing electricity by means of recovering hydraulic energy by implanting new technology based on pumps working as turbines

Can oilfield water safely be reused for irrigation in California?
Reusing low-saline oilfield water mixed with surface water to irrigate farms in the Cawelo Water District of California does not pose major health risks, as some opponents of the practice have feared, a study led by Duke University and RTI International researchers finds.

Expansion, environmental impacts of irrigation by 2050 greatly underestimated
New research suggests that the amount of farmland that will need to be irrigated to feed the global population by 2050 could be up to several billion acres, far higher than scientists currently project.

Turned-down temperatures boost crops' penchant for production
Drought and heat put stress on plants and reduce grain yield.

Irrigation alleviates hot extremes
Researchers from ETH Zurich and other universities found evidence that expanding irrigation has dampened anthropogenic warming during hot days, with particularly strong effects over South Asia.

Specifying irrigation needs for container-grown plants
Open-field production of 524,000 irrigated acres of horticultural plants in the United States used 205 billion gallons of water in a recent year.

Water management grows farm profits
A study investigates effects of irrigation management on yield and profit.

Oil and gas wastewater used for irrigation may suppress plant immune systems
A new Colorado State University study gives pause to the idea of using oil and gas wastewater for irrigation.

Read More: Irrigation News and Irrigation Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.