Ingested lithium batteries cause gastrojejunal fistula

V.G. Mohan Prasad, DM, FRCP (Edin), from the VGM Hospital, Coimbatore,  in Tamil Nadu, India presents this video case “Spontaneous magnetic gastrojejunal fistula caused by accidentally ingested lithium batteries.”

In this video, we demonstrate a case of a gastrojejunal (GJ) fistula created by accidental ingestion of lithium batteries. This young man of 25 had gulped batteries with alcoholic beverage four months before endoscopy. Endoscopic attempt to remove the “foreign object” in the stomach in another center failed.

When  we did the endoscopy, we saw 2 coin-like objects in the necrotic ulcer-base on the posterior wall of gastric corpus.  On removal with foreign–body forceps, the batteries flew back and got stuck to the original location.

This prompted us to have fluoroscopy done which showed further such batteries in the DJ flexure, which we removed using a Roth Net Basket.

When a magnetic object is attracted to the posterior wall of stomach, one should look for more magnetic objects in the 4th part of the duodenum or jejunum. In the 1990s, “Endoscopic Magnetic Gastro Jejunostomy” was demonstrated, wherein endoscopist actively placed a magnet in the DJ flexure and another magnet on the posterior wall of gastric corpus and came out. The 2 magnets stuck to each other. By pressure necrosis, the intervening gastric and duodenal walls gave away producing a gastrojejunal fistula. A self-expandable metal “YoYo” stent was placed to expand the track and to maintain patency. This was useful in patients of poor surgical risk for PGJ and also inoperable malignant tumors of 2nd or 3rd parts of duodenum. In this case, unknowingly the patient underwent the same process, leading to spontaneous GJ fistula.

Spraying collagen over the necrotic ulcerated area in gastric corpus after removing the batteries helped in expediting the healing process. During the natural healing process, collagen comes into play by day 7 after the acute mucosal injury. Spraying “egg-cell-membrane collagen” starts the healing process instantaneously.

While endoscopic sprays are available for hemostatic purposes in some countries, these are inert mineral or vegetable powders which can act as a mechanical barrier over the bleeding lesion, but are not helpful in the healing process. Spraying collagen can help as a hemostat in bleeding lesions, as well as enhance healing. We have tried endoscopic collagen spray in a series of 68 patients of varied indications, with no adverse events and with great benefit.

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