Endoscopic Battery Removal
George, a 10 month old Golden Retriever/Poodle mix (Golden Doodle), presented to our hospital because his owner thought he may have eaten two AA batteries. He was showing no abnormal clinical signs. On presentation, George was bright, alert and responsive, with no abdominal discomfort and no signs of nausea. Abdominal x-rays were taken and confirmed the presence of two AA batteries in the stomach. Due to the concern for esophageal and gastric ulceration with battery degradation, removal was recommended as soon as possible.
The owner was given the option of invasively removing the batteries via surgical gastrotomy, or alternatively performing a non-invasive endoscopic procedure to attempt visualization and removal of the batteries via the esophagus and mouth. The owner elected to pursue the non-invasive option of endoscopic removal.
George was placed under general anesthesia, and Dr. Tara Trotman, one of our two board certified internal medicine specialists with training in many different types of endoscopic procedures, including foreign body removal, performed the procedure. The endoscope was placed into the stomach via the mouth and esophagus, enabling visualization of the
esophagus, lower esophageal sphincter, and gastric mucosa and gastric contents. Entrance into the stomach was immediately met with visualization of multiple buttons consistent with those found on a remote control, as well as two AA batteries. There were other smaller pieces of material present, along with a larger piece that upon removal appeared to be a digested rawhide bone. The fluid present in the stomach was suctioned through the endoscope to allow for better visualization, and a snare specific for use in an endoscope was placed through the scope into the patient's stomach. The scope and snare were directed to the batteries, and each was individually grabbed via the snare, and pulled out of the stomach via the esophagus and mouth. It was easy to see that neither battery had become damaged at the time of the procedure, which may have made removal through the esophagus contraindicated due to the possibility of severe ulceration if the corrosive battery fluid was leaking. Several of the larger pieces of remote control were also removed in this fashion, and then a small piece of cloth-like material was removed using an alligator-forcep that was passed through the scope and directed to the foreign material.
George recovered fully and quickly, and went home the following day.
Endoscopic foreign body removal is a non-invasive method that can allow for shorter recovery times and fewer complications with lower morbidity than surgery. Many patients that have foreign bodies removed via endoscopy can go home the same day, in contrast to those requiring surgical removal in which the patient often remains hospitalized for several days following the procedure. Numerous instruments designed specifically for the endoscope can be helpful in retrieving many different types of foreign bodies that our veterinary patients can ingest. Although there are limitations to its use (ie - size of the object can make it difficult to remove through the lower esophageal sphincter in some cases, the presence of food or a large amount of material can impede visualization), the vast majority of gastric foreign bodies can be removed using endoscopy, thus sparing the patient an invasive surgical procedure. Removal of objects such as batteries, needles, coins (especially pennies that may be associated with hemolytic anemia), toys, etc. can often be performed via endoscopy. Patients that are regurgitating and have radiographs consistent with an esophageal foreign body can greatly benefit from esophagoscopy, which if successful could avoid a thoracotomy. Fish hooks can often be removed this way as well.
Endoscopy is an excellent non-invasive tool that can significantly reduce morbidity rates, hospitalization time, and often cost. In addition to foreign body removal, it can be used to obtain gastric, duodenal, colonic and/or cecal biopsy samples, visualize gastric mucosa to diagnose ulcers, and evaluate the nasopharynx, urethra and bladder mucosa. If you have a case that might need endoscopic evaluation, please call to discuss with our referral coordinator to schedule an evaluation by one of our internal medicine specialists, Dr. Tara Trotman or Dr. Tabitha Hutton.
Tara Trotman, VMD, DACVIM