From the Guidelines
The recommended approach for this 22-year-old patient with schizophrenia who has ingested a disc battery is to perform EGD (esophagogastroduodenoscopy) within 2 hours, as emergent flexible endoscopy is recommended for button/disk battery ingestion due to the risk of pressure necrosis, electrical burns, and chemical injury 1. This is urgent because disc batteries lodged in the esophagus represent a medical emergency. Batteries can cause severe tissue damage through direct electrical current, pressure necrosis, and leakage of alkaline contents, potentially leading to esophageal perforation, fistula formation, or major vessel erosion within hours. The radiograph showing the battery in the distal esophagus indicates it has not passed into the stomach, where risks would be lower. Some key points to consider in the management of this patient include:
- Observation is inappropriate given the location and nature of the foreign body.
- Waiting 24 hours would be too long considering the rapid tissue damage that can occur.
- Medications to encourage evacuation are ineffective for esophageal foreign bodies and could potentially worsen the situation. After removal, the patient will need psychiatric reevaluation of his medication regimen, as his repeated foreign body ingestion suggests his schizophrenia symptoms may not be adequately controlled on his current Seroquel (quetiapine) therapy, and consideration of treatment options such as cognitive-behavioral therapy for psychosis (CBTp), psychoeducation, and supported employment services may be necessary 1. It is also important to consider the patient's overall health and well-being, including his physical health, and to provide a comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments for schizophrenia 1.
From the Research
Management of Disc Battery Ingestion
- The patient has a history of ingesting foreign objects and has been managed for paranoid schizophrenia, but the current concern is the ingestion of a disc battery, which requires immediate attention 2.
- The presence of a disc battery in the distal esophagus, as shown on abdominal radiography, indicates a high risk of esophageal damage and potential perforation 2, 3.
- The management of esophageal disc battery ingestion typically involves emergency endoscopic removal to prevent severe injury, which can occur rapidly following ingestion 2, 4.
Endoscopic Removal and Follow-up
- Endoscopic removal of the disc battery is necessary to prevent further damage to the esophagus, and this procedure should be performed within 12 hours of ingestion 2, 5.
- After endoscopic removal, follow-up care is crucial to monitor for potential complications, such as esophageal perforation or retained metal fragments, which can cause thermal injury during MRI 6.
- The patient's condition should be closely monitored, and any signs of distress or complications should be addressed promptly.
Treatment Options
- The treatment options for esophageal perforation, which can occur as a result of disc battery ingestion, include endoscopic closure techniques, such as through-the-scope clips, over-the-scope clips, and esophageal stent placement 3, 5.
- In some cases, endoscopic suturing or endoluminal vacuum therapy may be used to manage esophageal perforations and prevent further complications 5.
- The choice of treatment depends on the severity of the injury, the location of the perforation, and the patient's overall medical condition 3.