Acquired Tracheoesophageal Fistula Following Lithium Battery Ingestion: Urgency in Diagnosis and Management Challenges

Introduction Acquired tracheoesophageal fistula (aTEF) resulting from button battery ingestion (BBI) present significant management challenges due to high morbidity and recurrence rates following surgery [1,2,3]. Early diagnosis and prompt intervention are crucial for optimal outcomes. This case report highlights the importance of proper management of both BBI and TEF to improve clinical outcomes and reduce long-term complications. Case Presentation An 11-month-old boy presented to the emergency department 1 hour after lithium battery ingestion. It was immediately removed by a flexible esophagoscope. A week later the patient presented with respiratory distress and dysphagia. A contrast x-ray suggested aTEF, which was confirmed by chest CT and endoscopy. The patient was taken to the operating room for nasogastric tube insertion and intubation to maintain esophageal and tracheal patency and prevent aspiration. Furthermore, a gastrostomy was formed to maintain enteral feeding. The patient was treated in pediatric intensive care for 9 days, under sedation and mechanical ventilation. The patient's condition continued to deteriorate, leading to thoracotomy and aTEF repair. A month later, due to concerns about the fistula reopening, it was confirmed by a bronchoscopy. A second tracheoplasty and esophagoplasty were performed, and the gastrostomy was removed 2 months later. A follow-up at 15 months, no issues regarding breathing or swallowing reported. Discussion BBI can lead to rapid, severe complications including aTEF [1]. While some cases of aTEF respond to conservative management [4,5,6], surgical repair remains definitive treatment [1]. Endoscopic stenting can serve as a temporary bridging technique [4,6]. The present case highlights the potential for failure of conservative approaches and emphasizes the need for prompt surgical intervention when necessary to avoid significant complications. Conclusions This case demonstrates the importance of prompt surgical intervention for aTEF resulting from BBI, particularly when conservative management fails. Early diagnosis and appropriate surgical intervention can significantly improve clinical outcomes and reduce long-term complications.