Introduction

Button battery ingestion represents one of the most high-risk pediatric foreign body emergencies, accounting for up to one-quarter of cases and increasing in frequency due to the widespread use of household electronics [1-3]. When lodged in the esophagus, button batteries can cause rapid corrosive injury, with full-thickness necrosis developing within hours due to electrolysis [4]. The absence of a serosal layer renders the esophagus particularly susceptible to life-threatening complications, with reported pediatric mortality rates up to 30% [5]. Major sequelae include esophageal perforation, tracheoesophageal fistula, and aortoesophageal fistula [2]. Therefore, urgent endoscopic removal, ideally within two hours of ingestion, is essential to reduce the risk of catastrophic injury [1-3,6].

Management of esophageal perforation remains challenging, with no universally accepted gold standard [7]. Therapeutic options range from conservative to surgical, depending on the extent of injury and clinical stability. In children, conservative management is often attempted initially; however, surgical intervention becomes necessary if deterioration, uncontrolled sepsis, or persistent leakage occurs [5,8,9]. Surgical options include primary repair, diversion or exclusion procedures when primary repair is not feasible, resection for extensive tissue destruction, and, in selected stable patients, endoscopic approaches [6,10,11].

We report the case of a six-year-old boy with distal esophageal perforation following button battery impaction. Initial conservative treatment and subsequent diversion with loop esophagostomy were unsuccessful, as persistent bilious drainage from both the esophagostomy and chest drains indicated ongoing contamination. A salvage procedure employing temporary esophageal exclusion with proximal and distal absorbable ligatures achieved complete isolation of the injured segment and rapid control of sepsis. Spontaneous recanalization occurred as the ligatures dissolved, restoring luminal continuity without the need for formal reanastomosis. This case demonstrates a rare pediatric application of a previously described temporary esophageal exclusion technique and underscores its potential as a relatively simple, organ-preserving salvage strategy in complex pediatric esophageal perforations.