A Case of Low Energy

I was in the hospital’s Endoscopy Suite the other day, as I had 7 bronchoscopies to do that day. Bronchoscopy is a procedure that we place a flexible fiberoptic scope into the patient’s airway to directly examine it. This is also how we get our biopsy if there is a lung mass, as well as to obtain specimen for cultures from deep inside the lungs.

With advance technology, we are now able to biopsy even very small spot in the lungs, as we now use robotic-assisted bronchoscopy that uses a controller that is similar to a video game controller. It also uses a navigational system, like a GPS, so we can get to our spot accurately. It is really fun as it is like playing a video game with virtual and real-time images on the screen as I drive the robotic scope into the target lesion.

The only downside is that it needed to be done under general anesthesia and the procedure is kind of prolonged, usually takes 45 minutes to an hour for every procedure. Needless to say, I was in the endoscopy suite the whole day that day.

While I was doing my charting at the work room in between my cases, I noticed that one of my Gastrointestinal (GI) doctor colleague was kind of exasperated and not having a good day. GI doctors and colorectal surgeons, also use the Endoscopy Suite, besides us pulmonologists, for their endoscopic procedures.

I then overheard that he has a patient that he has to retrieve batteries from the patient’s esophagus or stomach because he swallowed them. Some people, especially children would accidentally swallow objects that are not food. But for this patient he deliberately swallows batteries for unknown purpose, or for reasons he alone knows.

The GI doctor said that he took care of this particular patient 3 days ago and also last week for the same problem. It seems that this patient is a frequent flyer in the hospital. Whenever he feels stressed and anxious, he swallows batteries. Maybe he experienced low-energy so he needed to eat batteries. Perhaps he should plug himself to an electric outlet for a bigger jolt of energy. Just kidding!

What happens when you swallow a lithium battery? In the case of this patient, he usually swallows cylindrical AA batteries. Here’s what can happen:

• Caustic Burns: Saliva can complete an electrical circuit around the battery, creating a chemical reaction that produces hydroxide (a strong alkali). This can burn through internal tissue in as little as 2 hours.
• Leakage of Toxic Contents: Cylindrical batteries contain heavy metals like lithium, zinc, manganese, and mercury. If the casing is damaged or eroded by stomach acid, these toxic materials can leak, causing severe mucosal damage and poisoning.
• Obstruction and Perforation: Due to their size, cylindrical batteries are at high risk of getting stuck (impaction), leading to bowel obstruction or puncturing the digestive tract wall (perforation).
• Internal Bleeding: The battery can erode into major blood vessels, causing catastrophic internal hemorrhage.

With these reasons, the GI doctor was compelled, even how irritated he was, to retrieve the batteries from the patient’s gut with a scope. However, sometimes nothing bad would happen, and the batteries would pass safely through the GI tract and the patient would just poop them out. Talk about energy leaving your body!

Of course, people can swallow other foreign objects, accidental or intentional, besides batteries. Dentures, spoons, forks, nails, coins, jewelry, pins, and anything else that you can imagine.

I remember when I was in medical school, they presented in our Grand Rounds a case of a man with some mental issues who complained of abdominal pain. Of course he would not divulge what exactly he did. So after some testing, including an x-ray of the abdomen, that the diagnosis was established.

On the abdominal x-ray, it showed 3 teaspoons in different portions of his small intestines. Did he literally swallowed 3 teaspoons when he took his medicine?

Below is an x-ray I found in the internet. Can you identify the objects this person ingested?

Back to our GI’s patient, he was not able to retrieve the batteries, as it already passed beyond the stomach and proximal small intestine. He just have to wait for the batteries to pass through the whole GI tract, or if it get stuck somewhere that cannot be reached by a scope, then our surgeon colleagues can open him up and retrieve them.

How long would this patient keep on eating batteries? How long would he feel low-energy? I hope he does not inhale them (lodge into his air pipes), or the problem will fall into my lap. That would be a breath of energy!