An Accidental Ingestion Of A Hearing Aid Including A Litium-Ion Rechargeable Battery Which Resulted In Spontaneous Excretion

　認知機能障害がある高齢者は，異物誤飲を生じるリスクとなりうる．これは認知症の併存によって誤飲の事実を患者本人が認知していないことや異物誤飲による症状が非特異的，もしくは無症候性であることが多いことと関係している．このため認知機能障害のある高齢者において異物誤飲は発見が遅れる可能性がある．リチウムイオン充電式電池を内蔵した補聴器の誤飲が MRI の撮像を契機に発覚し，その後合併症なく自然排泄が得られた症例を経験したので報告する．症例は 82歳女性，尿路感染の診断で入院となった．入院時から不穏行動があり，感染症によるせん妄が疑われた．入院２日目に補聴器を紛失したと訴え捜索を行ったが発見できなかった．入院４日目に腰椎圧迫骨折の精査目的で行った MRI 検査において腹腔内に強いアーチファクトを認め，補聴器の誤飲が疑われた．腹部 CT 検査を行い，補聴器であることを確認した．補聴器が充電式であることやトライツ靭帯を超え横行結腸に存在していることから外科的摘出を行わず自然排泄を待つこととした．その後，異物・電池誤飲に伴う腸管症状をきたすことなく経過し，入院５日目に補聴器が自然排泄された．精神疾患患者や高齢患者など，誤飲を生じうる患者が嚥下可能なサイズの装着物を紛失した際には，Ｘ線検査を行うことで発見できる可能性がある．異物誤飲に伴う腸閉塞や腸管損傷に加え，補聴器に使用されている電池がボタン型電池であるのか内蔵型の充電式電池であるのかによって，誤飲に伴う合併症の有無を評価し，対応する必要がある .　Delirium during hospitalization in elderly patients is a risk factor for accidental foreign body ingestion. The patient may not be aware of the fact that he or she has ingested foreign bodies due to coexisting dementia, and the symptoms of foreign body ingestion are often nonspecific or asymptomatic, which may delay the detection of the accidental ingestion. We report a case in which an accidental ingestion of a hearing aid containing a rechargeable battery was detected with the opportunity of MRI imaging, and the patient underwent spontaneous elimination without complications. An 82-year-old woman was admitted to the hospital with a diagnosis of urinary tract infection and was suspected to have delirium due to the infection because of her disturbing behavior from the time of her arrival. On day 2 of admission, she reported that she had lost her hearing aid, and a search was conducted but failed to find it. On day 4, an MRI scan performed to investigate complications revealed strong artifacts in the abdominal cavity, which led us to suspect that the patient had swallowed a hearing aid by mistake. An abdominal CT scan was performed and confirmed to be a hearing aid. The patient did not have any intestinal symptoms associated with ingestion of a foreign body or battery, and spontaneous excretion of the battery was obtained on day 5. When patients with psychiatric disorders or elderly patients who is at risk of accidental ingestion lose a swallowable size equipment, radiographic examination may help detect in such cases. In addition to intestinal obstruction and damage to the intestinal tract associated with ingestion of foreign objects, the presence or absence of complications associated with ingestion of batteries due to button batteries or rechargeable batteries in hearing aids should be evaluated and discussed with each department regarding the appropriate response

自然排泄したリチウムイオン充電式補聴器の誤飲

症例報告Case Reportjournal articl

Heat stroke management during the COVID‐19 pandemic: Recommendations from the experts in Japan (2nd edition)

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