An 18-year-old girl with retrosternal burning discomfort: a bitter pill to swallow

Caustic injury secondary to impaction of ingested batteries is a potentially severe cause of oesophageal injury with an increasing incidence that reflects consumer trends and the utilisation of compact electronic devices. Delays to recognition and management are associated with increased risk of complications, morbidity and mortality. In this manuscript, we describe a case presentation and literature review of a patient presenting with upper oesophageal odynophagia after the deliberate ingestion of multiple foreign bodies.

Survival of Toddler with Aortoesophageal Fistula after Button Battery Ingestion

Button batteries (BBs) are found in many households and are a source of esophageal foreign body in the pediatric population. Upon ingestion, significant caustic injury can occur within 2 hours leading to tissue damage and severe, potentially fatal sequelae. Aortoesophageal fistula (AEF) is a rare complication that nearly always results in mortality. We report a rare case of a toddler who developed an AEF after BB ingestion and survived following staged aortic repair. There should be a high index of suspicion for this complication with the history of BB ingestion and presence of hematemesis, hemoptysis, or melena.

Miscellaneous

This chapter includes a range of miscellaneous curriculum topics including endoscopy, anorectal disorders and gastrointestinal (GI) investigations. Questions discussing the role and indications for antibiotic prophylaxis in endoscopy, sedation, performance measures and consent will provide education on best practice in endoscopy. Coverage is also given to the management of anticoagulation pre- and post-endoscopy together with commonly encountered procedural complications: post-polypectomy syndrome, post-endoscopic retrograde cholangiopancreatography pancreatitis and caustic injury. The presentation and management of key anorectal disorders (haemorrhoids, anal fissures, anal intraepithelial neoplasia, infectious proctitis) are also presented here. Finally, principles of salient GI investigations including anorectal manometry and breath tests are well described. Additional curriculum material regarding miscellaneous gastrointestinal conditions and investigations will be covered in the mock examination chapter.

Utilization of Chest Tube in Pediatric Caustic Injuries: A New Method for Esophageal Stenting

Background: The management of caustic esophageal burns in the pediatric population has changed over the years, while the most optimal management with regards to effectiveness, availability, and cost-beneficent stays controvertible. Herein, along with describing the features of caustic injury, we described how to utilize a chest tube for esophageal stenting in pediatrics.Methods: Data regarding the etiology, treatment, and complications of caustic injury pediatrics during 10 years was collected retrospectively. Furthermore, data regarding the patient’s follow-up who underwent esophageal chest tube (ECT) were collected. The ECT was prepared by carving a narrowed section in the chest tube while maintaining the radiopaque section. The ECT will then be positioned from the cricopharyngeal and exited through the nostril and fixed on the patients’ cheek.Results: Data from 57 patients with an average age of 2.5 years was collected. The most common cause of esophageal burn appertained to alkaline agents (89%). Twenty-nine patients (50.8%) recovered with dilatation alone, 16 ones needed esophageal repair, and ECT was inserted for 7 patients. None of the 7 ECT cases required gastrostomy or jejunostomy.Conclusion: The ECT method introduced in our study can be used as a broadly available, economic, and easy-use facility for esophageal stenting, particularly in developing countries and emergency departments which have limited access to modern equipment. Further multicenter studies with higher volume patients are required for further deployment of this method.