Temporary Esophageal Exclusion With Absorbable Ligatures: A Salvage Strategy for Pediatric Button Battery-Related Perforation

Button battery ingestion constitutes a life-threatening pediatric emergency, particularly when impacted in the esophagus, causing rapid tissue necrosis. Esophageal perforation is among its most severe sequelae, yet optimal management remains unclear. Organ-preserving strategies are especially important in children but are rarely reported. We report a case of a six-year-old boy who developed distal esophageal perforation following button battery impaction. Initial endoscopic removal and conservative management were insufficient, necessitating subsequent thoracotomy, loop cervical esophagostomy, and Stamm gastrostomy. Persistent bilious drainage from the esophagostomy and chest drains prompted a salvage technique using proximal and distal absorbable ligatures to exclude the injured esophagus. This achieved rapid sepsis control while preserving the native esophagus. Spontaneous recanalization occurred approximately two months after ligature placement, following their gradual dissolution, restoring continuity without formal reanastomosis. This case suggests that temporary esophageal exclusion with absorbable ligatures is a feasible, simple, and organ-preserving salvage option, expanding the therapeutic armamentarium for pediatric surgeons managing complex esophageal perforations after button battery ingestion.