A toddler rides in a green wagon down a hospital hallway.

Toddler’s throat healing after swallowing button batteries

As Megan and RJ Hulleman sit on a date with their daughter Remi, they can’t help but be grateful.

Grateful for each other, grateful for Sanford Health, and most importantly, grateful that their daughter Remi is alive.

The accident happened quickly

The Hullemans call Orange City, Iowa home. They were relaxing on a warm, peaceful Sunday morning in July when 15-month-old Remi had an accident that changed the dynamics of their day, and still today, of their lives.

“Remi was playing with one of those fan remotes; they are about the size of an egg. It fell on the floor and two of the button batteries came out,” said Megan Hulleman, Remi’s mother.

“Remi is really good at bringing you things if you ask him. She brought me the batteries and I sat them on the sofa on the armrest. I picked her up, she grabbed her cup, drank a little, then threw the cup aside. When I went to get the cup, she reached out, grabbed the batteries, and I heard her cough. Instantly, I knew (what happened). My stomach just sank,” she added.

Megan knew immediately that Rémi had swallowed a battery.

“The first thing I tried to do was use my finger to push it out. I couldn’t feel anything, but she was coughing and you could tell she was choking on something,” Hulleman said. .

RJ and Megan rushed Remi to the Orange City ER.

“The minute they read the X-ray they said, ‘No, we don’t do that here in Orange City. We are not prepared for this. We’ll send you to Sioux Falls. We really enjoyed that with Orange City – acknowledging that it was coming out of their wheelhouse,” Hulleman said.

Why swallowing a battery is an emergency

Patrick Munson, MD, is the chief of pediatric otolaryngology at Sanford Health in Sioux Falls, South Dakota. He said Rémi had swallowed a disc or a lithium battery. These types of batteries are usually the size of small coins or buttons.

Dr Munson said when these types of batteries are swallowed it is imperative to remove them as soon as possible “because of the charge they have”.

“It can cause destruction and erode the tissues of the esophagus. So it’s really an emergency to get out,” he said. “We had her transferred to the children’s hospital, where she went straight to the OR. Normally in these situations we have special scopes where we look at the esophagus and then we use a special grasping device to grab them,” Dr. Munson added.

Dr. Munson tried and tried and tried but couldn’t grab the battery.

“I remember waiting in the waiting room and saying to RJ, ‘I know there’s a second drum set at home.’ Well, 45 minutes later my stomach sank again. They said they were having trouble getting it out and wondered if there was a possibility of two batteries being stuck together,” Hulleman said.

Expand Rémi’s care team

Rémi swallowed the two batteries of the remote control. They were stacked on top of each other, making the esophagus so tight that Dr. Munson could not grasp them. He knew Remi would need more care and called Adam Gorra, MD, pediatric surgeon and medical director of pediatric trauma at Sanford Children’s Hospital in Sioux Falls, South Dakota.

Dr. Gorra and Dr. Munson worked together and decided the best way to help Remi was to push the buttons in his stomach. Then, from there, they would open his stomach and remove the batteries.

“It was a unique situation. None of us had ever been in this kind of scenario before. We had to improvise and do what we thought was best for the patient at the time,” Dr. Gorra said.

The two worked together for over four hours to get the batteries out.

“I couldn’t have done it without him. He couldn’t have done it without me. I think we brought something special to the situation, and it really benefited the patient,” Dr. Gorra said.

The Hullemans said Dr. Gorra and Dr. Munson made them feel like part of the care team.

“They would come back and meet with us several times in the waiting room to give us updates on what was going on. They even made us drawings to show us what they were doing, which was really nice. I think the most important thing is that they kept reassuring us that they wanted to keep the best result for Remi,” they said.

“I appreciated their patience and understanding with us. One weekend, I think I sent about five My Sanford Chart messages, and they responded to all of them, which is huge,” they added.

Road to recovery

Doctors managed to remove the batteries, but noticed that they had caused a small hole in Remi’s esophagus while they were lodged there. They patched the hole and knew it would take Remi a while to fully recover.

Rémi was hospitalized for two weeks before being told she could go home, but with severe dietary restrictions. She is currently still on a liquid-only diet to help her esophagus heal.

Part of the recovery is slowly returning to solid foods. To do this, Remi had to come in several times for an endoscopy, a procedure to look inside a patient’s body and dilate their esophageal structure.

Essentially, Dr. Gorra is slowly stretching Remi’s esophagus. He can’t stretch it all at once, at the risk of hurting Rémi. Each time they do this procedure, the goal is to stretch it two millimeters. Once they reach 10 millimeters, Remi can switch to completely solid foods.

“I guess we’ll do this type of procedure twice more,” the Hullemans said.

Regardless of how long Remi recovers, the Hullemans say they are reassured to know that Remi is receiving the best care possible.

“We couldn’t have asked for a better team.

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Posted in Children, Otorhinolaryngology, Emergency medicine, General surgery, Specialized care

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