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Toddler’s throat healing after swallowing button batteries

As Megan and RJ Hulleman sit in a checkup appointment with their daughter Remi, they can’t help but feel grateful.
Grateful for each other, grateful for Sanford Health, and most importantly, grateful their daughter Remi is alive.
The Hullemans call Orange City, Iowa home. They were relaxing on a warm and peaceful Sunday morning in July, when 15-month-old Remi had an accident that changed the dynamic of their day, and still to this day, their life.
“Remi was playing with one of those fan remotes; they’re about the size of an egg. It dropped on the floor, and two of the button batteries popped out of it,” Megan Hulleman, Remi’s mother, explained.
“Remi’s really good at bringing things to you if you ask her to. She brought the batteries to me, and I sat them up on the couch on the armrest. I picked her up, she grabbed her sippy cup, drank for a little, then chucked the cup to the side. When I went to grab the sippy cup, she reached over, grabbed the batteries, and I heard her cough. Instantly, I knew (what happened). My stomach just sank,” she added.
Megan immediately knew Remi swallowed a battery.
“The first thing I tried doing was using my finger to get it out. I couldn’t feel anything, but she was coughing, and you could tell she was choking on something,” said Hulleman.
RJ and Megan rushed Remi to the ER in Orange City.
“The minute they read the X-ray, they said, ‘nope, we’re not doing it here in Orange City. We’re not prepared for this. We’re going to send you to Sioux Falls.’ We really appreciated that with Orange City – recognizing that this was out of their wheelhouse,” Hulleman said.
Patrick Munson, M.D., is the head of pediatric ear, nose and throat at Sanford Health in Sioux Falls, South Dakota. He said Remi swallowed a disk, or lithium, battery. These types of batteries are typically the size of small coins or buttons.
Dr. Munson said when these types of batteries are swallowed, it’s imperative to remove them as quickly as possible “because of the charge that they have.”
“It can cause destruction and erode the tissue of the esophagus. So, it really is an emergency to get out,” he said. “We had her transferred to the children’s hospital, where she went directly into the operating room. Normally in these situations, we have special scopes where we look down the esophagus, and then we use a special grasping device to grab them out,” 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 battery at home.’ Well, 45 minutes later, my stomach sunk again. They said they’re having a hard time getting it out and were wondering if there’s a possibility there’s two batteries stuck together,” Hulleman said.
Remi swallowed both batteries from the remote. They were stacked on top of each other, making the esophagus so tight that Dr. Munson couldn’t grab them. He knew Remi would need more care, and called Adam Gorra, M.D., a pediatric surgeon and medical director for 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 into her stomach. Then from there, they’d open her stomach and pull the batteries out.
“This was a unique situation. Neither of us had ever been in that kind of scenario before. We had to improvise and do what we thought was best for the patient at the time,” said Dr. Gorra.
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 that really benefitted the patient,” said Dr. Gorra.
The Hullemans said Dr. Gorra and Dr. Munson made them feel like they were part of the care team.
“They would come back and meet with us in the waiting room multiple times to give us updates on what was going on. They even drew pictures for us to show us what they were doing, which was really nice. I think the biggest thing is they kept reassuring us that they wanted to keep the best outcome for Remi,” they said.
“I appreciated their patience and understanding with us. One weekend, I think I sent like five My Sanford Chart messages, and they answered every one of them, which is huge,” they added.
The doctors successfully removed the batteries but noticed they did cause a small hole in Remi’s esophagus while they were lodged in there. They repaired the hole and knew that it would take Remi a while to fully recover.
Remi was hospitalized for two weeks before being told she could go home, albeit with heavy dietary restrictions. She’s currently still on a liquid-only diet, to help her esophagus heal.
Part of the recovery is slowly moving back to solid foods. To do this, Remi has had to come in multiple times for endoscopy, a procedure to look inside a patient’s body, and a dilation of her esophageal structure.
Essentially, Dr. Gorra slowly stretches out Remi’s esophagus. He can’t stretch it out all at once, for risk of injuring Remi. Each time they do this procedure, the goal is to stretch it out by two millimeters. Once they get up to 10 millimeters, Remi can move to fully solid foods.
“I would guess we’ll do this type of procedure another two times,” said the Hullemans.
However long Remi’s recovery lasts, the Hullemans said they’re comforted knowing Remi’s receiving the best possible care.
“We couldn’t have asked for a better team.”

Posted In Children’s, Ear, Nose & Throat, Emergency Medicine, General Surgery, Specialty Care

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