Conclusions

This case underscores the importance of a stepwise, individualized approach to pediatric esophageal perforation following button battery ingestion, with escalation from conservative management to surgical intervention when initial measures fail. Temporary esophageal exclusion using proximal and distal absorbable ligatures allowed complete isolation of the injured segment and proved to be an effective salvage technique. In our patient, this approach achieved control of ongoing mediastinal contamination and sepsis after failure of conservative and diversion measures, while preserving the native esophagus. Spontaneous restoration of esophageal continuity occurred as the ligatures dissolved, without the need for formal reconstructive surgery. In the absence of a universally accepted treatment protocol, the outcome of this case suggests that temporary esophageal exclusion may offer a relatively simple, reversible, and organ-preserving salvage option, expanding the pediatric surgical armamentarium for managing severe esophageal perforation. However, the evidence remains limited to case reports and small case series, precluding definitive conclusions. Further clinical evidence is needed to better define the indications, safety, effectiveness, and long-term outcomes of this technique.