Histopathological Analysis of Esophageal Damage Caused by Coin-Shaped Lithium Batteries in Living Piglets

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BACKGROUND: More than 3,000 cases of accidental ingestion of coin-shaped lithium batteries (CSLBs) have been reported in the United States. Battery ingestion can cause serious injury and even death. Prior reports have indicated that complications often occur two or more hours after ingestion. However, to date, the temporal changes in esophageal damage remain unclear. To address this knowledge gap, we examined the histological features associated with these temporal changes. METHODS: Six piglets were used as models. After laparotomy and thoracotomy, three CSLBs were inserted into the esophagus of each pig. The esophagi were removed for histological examination at 0.5, 1, 2, 4, 6, and 8 hours. The consumed capacities of the batteries were measured after removal. RESULTS: Mucosal damage began at the margins of batteries, gradually spreading to the centers of the negative pole. At 0.5 hours after implantation, although necrosis at the limbus had reached the muscle layer, it became more extensive with time. At six hours, the full-thickness wall was damaged in all areas of the negative pole. The consumed capacity increased markedly after six hours, at which point holes opened in the outer case on the positive pole of the battery with observed electrolyte leakage. The consumed capacity was correlated with the amount of alkaline hydroxide ions. CONCLUSION: Our study revealed changes over time in injury site and depth. Although early diagnosis and treatment are necessary, managing batteries to avoid complications is also important. Additionally, developing safer batteries is warranted.

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