Journal of Paediatric Care Insight A Deep Esophageal Injury from a Lithium Battery: A Case Report

Abstract Context: Over the last ten years the ingestion of disk batteries and its serious consequences have been increasing. The severity of injury is related to a growing diffusion of the new lithium battery that may cause catastrophic damages when lodged in the esophagus in children. Case report: A five-year-old boypresented to the Emergency Department of our tertiary pediatric Institute for a lithium battery lodged in the mid esophagus. Emergent esophagoscopy revealed a severe deep, mild bleeding ulceration of the wall in which the battery was partially wedged. The investigation was stopped and on-call cardio-vascular surgeon started left thoracotomy to exclude damages of the main vessels. With the thorax open, the endoscopy was repeated and a directional relationship between the battery and the aorta was excluded by means of transillumination. The cell, a CR2032 lithium battery, was then removed. Central line parenteral nutrition, i.v. omeprazole plus antibiotics were started with a drainage tube left in the chest. During the follow-up the child undergone several chest X-rays with the suspicion of esophageal perforation. Angio-TC done on day 7 showed air into the thickened esophageal wall and in the mediastinum with severe peri-aortic edema without lesion of the vessel. MRi performed on day 21 showed only a persistent thickening of the esophageal wall. On day 28 an esophagogram was normal and the child was discharged asymptomatic. Two months later the investigation was repeated resulting entirely normal. Conclusions: Treatment of disk battery ingestion requires a multidisciplinary approach that can be implemented only in a tertiary pediatric hospital. Surgery can play an important role. Severe complications can occur several days after battery removal

Sudden blindness in a child with Crohn’s disease

Inflammatory bowel disease (IBD) is often associated with extraintestinal manifestations (EIMs) such as optic neuritis (ON), although this has been described in only a few adult patients so far, all of whom were affected with Crohn’s disease (CD). Furthermore, ON and demyelinating diseases have been demonstrated to be more frequent in IBD patients than in control populations. In our current case report, we describe a child with active CD who developed sudden blindness due to bilateral ON that was not related to any known cause, and that promptly responded to a high dose of steroids. Investigations and a clinical follow-up have so far ruled out the development of demyelinating diseases in this patient. To our knowledge, this is the first report of ON in a pediatric patient with CD. Possible explanations for this case include an episodic EIM of an active bowel disease, an associated autoimmune disorder such as a recurrent isolated ON, the first manifestation of multiple sclerosis, or another demyelinating disease that could appear in a later follow-up

Phenotype and Disease Course of Early-onset Pediatric Inflammatory Bowel Disease

BACKGROUND: Early-onset (EO) pediatric inflammatory bowel diseases (IBD) seem to be more extensive than those with a later onset. To test this hypothesis, we examined the phenotype and disease course of patients with IBD diagnosis at 0 to 5 years, compared with the ranges 6 to 11 and 12 to 18 years. METHODS: Anatomic locations and behaviors were assessed according to Paris classification in 506 consecutive patients: 224 Crohn's disease, 245 ulcerative colitis, and 37 IBD-unclassified. RESULTS: Eleven percent of patients were in the range 0 to 5 years, 39% in 6 to 11 years, and 50% in 12 to 18 years. Ulcerative colitis was the most frequent diagnosis in EO-IBD and in 6- to 11-year-old group, whereas Crohn's disease was predominant in older children. A classification as IBD-unclassified was more common in the range 0 to 5 years compared with the other groups (P < 0.005). EO Crohn's disease showed a more frequent isolated colonic (P < 0.005) and upper gastrointestinal involvement than later-onset disease. Sixty-two percent of the patients in the 0 to 5 years range had pancolonic ulcerative colitis, compared with 38% of 6 to 11 years (P = 0.02) and 31% of 12-18 years (P = 0.002) range. No statistical difference for family history for IBD was found in the 3-year age groups. Therapies at the diagnosis were similar for all children. However, at latest follow-up, a significantly higher proportion of younger children were under steroids compared with older groups (P < 0.05). Surgical risk did not differ according to age. CONCLUSIONS: EO-IBD exhibits an extensive phenotype and benefit from aggressive treatment strategies, although surgical risk is similar to later-onset disease. A family history for IBD is not common in EO disease