coins are the most commonly ingested foreign bodies ( fb ) , with button batteries , fish bone , marble , stone , and pieces of meat , etc .
, being other forms of ingested fb . in majority of cases , it is accidental in nature but can be occasionally homicidal , as was probably the case in our patient .
we report the case of a female neonate who had a large button battery impacted in the upper one - third of esophagus .
a 3.1 kg , 12-day - old newborn girl was referred to the otorhinolaryngology ( ent ) department with complaints of vomiting , poor feeding , drooling of saliva , and mild cough for the past 10 days .
she suddenly developed complaints of vomiting , poor feeding , drooling of saliva , and later cough .
she had been kept at home under the care of her grandmother , despite these ailments , for almost a week before medical consultation was sought .
she had been shown to a local general practitioner who had treated her for 2 days and then referred her to the pediatric department in our hospital .
the pediatrician sent her for an ent consultation in view of the suspicious circumstances associated with the history . on examination ,
patient 's pulse rate was 142/ min , blood pressure was 75/50 mmhg , and respiratory rate was 40/ min .
she was mildly dehydrated , had no stridor but had reduced air entry in the basal region of chest . suspecting an fb , an x - ray neck , lateral and ap view , was done which revealed a rounded fb , 1  1 cm in size , impacted in the upper one - third of the esophagus at the level of t1-t2 [ figure 1 ] .
preoperative chest x - ray pa view with foreign body in situ anesthesia was induced with sevoflurane in oxygen and fentanyl 6 mcg was given intravenously .
rocuronium 3 mg was given intravenously and the airway was secured with a 3 mm i d endotracheal tube .
the fb was deeply impacted with intense surrounding edema . repeated attempts at retrieval proved unsuccessful .
after about 3 h the procedure was abandoned and the patient was shifted to pediatric intensive care unit ( picu ) . patient was put on synchronized intermittent mandatory ventilation ( simv ) with pressure support ventilation ( psv ) .
she was gradually weaned off and the trachea extubated after 6 h. the patient developed stridor with decrease in oxygen saturation and trachea was reintubated .
she was kept on the ventilator , on psv mode , till she was taken up for a repeat surgical procedure .
general anesthesia was induced with inhalation of sevoflurane in oxygen and fentanyl 6 mcg was given intravenously .
intraoperatively , because of tracheal compression and vagal stimulation by the rigid esophagoscopy , patient had polymorphic electrocardiographic ( ecg ) and heart rate changes , such as sinus bradycardia and tachycardia , low voltage qrs complexes , st segment depression , and st elevation . other vital parameters including oxygen saturation remained stable .
the esophageal mucosa was inflammed and edematous but surprisingly without any charring , blackening , or perforation .
the patient was shifted to the picu for observation and 2 days later to the ward after an uneventful recovery .
eighty percent of all fb esophagus occur in children , with a peak incidence in the age group of 6 months to 3 years . of the fbs that come to medical attention , 8090% passes through gastrointestinal tract without any difficulty , 1020% requires endoscopic removal , and only about 1% requires surgical intervention .
the fb in our case was lodged at the level of upper one - third of the esophagus .
x - ray neck , ap and lateral view , is most commonly done for diagnosis .
if the incident is not witnessed and the ingested object is radiolucent , the diagnosis of fb ingestion can be very difficult .
barium esophagoscopy , computed tomography scans of the neck , ultrasonography , and magnetic resonance imaging may be required for diagnosis .
apart from eroding into the trachea , the object can erode into the aorta , leading to exsanguinations and death .
fbs should be immediately removed on diagnosis , because they may rapidly cause direct tissue damage ( blackening , charring , liquefaction necrosis , and esophageal perforation ) , by pressure and by chemical and electrical burns .
surprisingly , in this case , the button battery had not caused much tissue damage , in spite of lying in situ for almost 10 days .
occurrence of fb ingestion in neonates is rare with only a few reported cases in literature .
it is seen in circumstances where it has been inserted into the mouth playfully by an elder sibling or homicidal attempts on an unwelcome female child . in the present case ,
the child was a third female child in a family wherein the only earning member was a poor rickshaw puller .
the grandmother had probably put the battery in the child 's mouth and then kept her at home for so many days hoping that she would succumb to it . in such cases ,
must be maintained when the child presents to a medical facility with symptoms related either to the respiratory or gastrointestinal tract .
respiratory distress is the most common manifestation of an fb in esophagus in neonates , and it can lead to misdiagnosis of a respiratory disorder . however , in this case , no history was forthcoming and there were no respiratory symptoms at presentation which is unusual . only high indexes of suspicion lead to the diagnosis . to conclude , we recommend that in case a female neonate , of lower socioeconomic status , presents with sudden onset of respiratory and gastrointestinal symptom a few days after birth , ingestion of a fb , constituting a form of child abuse or neglect with homicidal intentions should be suspected . with this in mind , an early diagnosis can be made and appropriate treatment instituted to avert serious morbidity and even mortality .
 foreign body ingestion in neonatal period is an uncommon occurrence , despite foreign ingestion being common among pediatric age group . 
 we report a rare case of foreign body esophagus in a 12-day - old female neonate causing obstructive symptoms after a homicidal attempt . 
 the unusual age and circumstances involving the ingestion of the foreign body prompted us to report this case . 
Introduction
Case Report
Discussion