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Experimental investigation of battery-induced esophageal burn injury in rabbits

Yoshikawa, Takuma MD; Asai, Satoshi MD, PhD; Takekawa, Yoshinori MD; Kida, Akinori MD; Ishikawa, Koichi MD, PhD

Laboratory Investigations
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Objective  In recent years, small high-performance batteries have become very popular. With this increasing miniaturization of batteries, clinicians have noted an increasing frequency rate of esophageal injury due to battery ingestion by infants. The sltuation is associated with severe injury to the esophagus due to the electrical current produced, particularly in the case of high-performance batteries producing high currents. The pathophysiologic features and complications of esophageal battery burns have not been thoroughly investigated. Our study intended to investigate the pathophysiologic features and complications of esophageal battery burn.

Design  Open, randomized, controlled study.

Setting  Experimental animal laboratory in a university hospital.

Subjects  Male adult mixed-breed rabbits, 22 wks old and weighing 3 to 3.5 kg.

Interventions  The experimental rabbit model of esophageal injury due to battery ingestion described herein was designed to study not only the direct influence of contact with the battery but also damage to neighboring tissues and the biochemical and pathologic mechanisms of injury. We investigated the relationship between the direction of the inserted battery and the mechanism underlying these complications. Esophageal burn injury was created by placing a 3-V battery into the esophagus for 9 hrs.

Measurements and Main Results  The cathode side of the esophagus became increasingly alkaline, while the anode side was acidic. Low-voltage battery burns are likely to be due to secondary chemical reactions caused by the electric current because of acid generated at the anode and alkall at the cathode using a micro pH meter. Injury was significantly more severe on the alkaline side when a battery was placed with its cathode directed toward the trachea. Alkaline complications affecting neighboring tissues were more severe than acid complications. These results indicate that as well as the esophageal mucosa itself being injured, deleterious effects are exerted on surrounding tissues, the severity of which vary depending on the orientation and duration of the battery being lodged in the esophagus.

Conclusions  The direction of the battery cathode, which produces alkali, is important in determining the severity of complications. Based on our investigation of the underlying mechanisms of these complications, we advocate the establishment of treatment guidelines for battery swallowing accidents. (Crit Care Med 1997; 25:2039-2044)

From the Departments of Otorhinolaryngology (Drs. Yoshikawa and Kida), Pharmacology (Drs. Yoshikawa, Asai, and Ishikawa), and 2nd Pathology (Dr. Takekawa), Nihon University School of Medicine, Itabashi, Tokyo, Japan.

Supported, in part, by The Science Research Promotion Fund from the Japan Private School Promotion Foundation.

Address requests for reprints to: Dr. Koichi Ishikawa, Department of Pharmacology, Nihon University School of Medicine, 30 Oyaguchi-Kami Machi, Itabashi, Tokyo 173, Japan.

© Williams & Wilkins 1997. All Rights Reserved.