Left Common Carotid Artery Pseudoaneurysm After Unwitnessed Lithium Button Battery Ingestion in a Toddler: Successful Endovascular Hemostasis Following Life-Threatening Bleeding
DOI:
https://doi.org/10.52340/GBMN.2026.01.01.161Keywords:
Button battery ingestion, esophageal injury, carotid-esophageal fistula, pseudoaneurysm, mediastinitis, endovascular therapy, pediatric hemorrhageAbstract
The landscape of pediatric injury has shifted dramatically alongside the strategic evolution of household electronics. As consumer technology pursues extreme miniaturization, manufacturers have increasingly transitioned to high-energy-density lithium-ion chemistries. The strategic challenge for the clinician is that a battery small enough to be swallowed by infants and toddlers is often large enough to bridge the esophageal lumen, initiating catastrophic tissue destruction within minutes. Commonly, mucosal injury begins within 15 minutes, and full-thickness burns can occur within 4 hours, with severe complications, such as vocal cord paralysis, spondylodiscitis, aorto-esophageal stricture/stenosis, tracheoesophageal fistula (TEF), or aorto-esophageal fistula (AEF). In the article, we present a successful multidisciplinary management of an extremely rare clinical case: a 2-year-old female patient with trisomy 21 who experienced severe bleeding from a left carotid pseudoaneurysm following ingestion of a CR2032 3V Lithium button battery, treated with endovascular repair. This case highlights that (i) severe injury may evolve despite early removal, (ii) bleeding after button battery ingestion warrants urgent vascular evaluation, and (iii) carotid-esophageal fistula, though rare, should be considered in recurrent bright-red hematemesis following esophageal button battery injury.References
Dimensions: Typically, 5-25 mm in diameter and 1-6 mm in height. The 20 mm diameter lithium cell is the most significant driver of severe morbidity due to its propensity for esophageal impaction.
Chemistry: Formulations include lithium, silver, zinc, and heavy metals such as nickel, cadmium, and mercury.
Caustic Electrolytes: High concentrations of potassium hydroxide or sodium hydroxide.
a pediatric case of left common carotid-esophageal fistula after button battery ingestion that later progressed to a pseudoaneurysm, treated with a flow-diversion stent,14 and
a separate 2025 pediatric case of catastrophic upper GI bleeding from a left common carotid pseudoaneurysm after button battery ingestion.15
Primary repair/oversewing of the arterial defect.14
Patch repair (patch angioplasty), including bovine pericardial patch repair.14
Segmental resection with reconstruction/anastomosis of the injured vessel.14
Interposition graft replacement: (i) Polytetrafluoroethylene (PTFE)/Gore-Tex graft for carotid reconstruction, and (ii) Dacron / Gelweave graft for aortic repairs.14
Covered endovascular stent-graft as emergency closure of the fistula or pseudoaneurysm, especially in unstable patients.14,17
Flow-diversion stent for delayed carotid pseudoaneurysm after fistula repair.14
Neuroangiographic assessment of collateral flow / Circle of Willis is important before accepting carotid sacrifice.
If collateral flow is inadequate, carotid reconstruction/preservation is favored over simple sacrifice.
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