When Megan and RJ Hulleman have a check-up appointment with their daughter, Remi, they can’t help but be grateful.
Grateful for each other, grateful for Sanford Health and most of all grateful that their daughter Remi is alive.
Accident happened quickly
The Hullemans call Orange City, Iowa home. They were relaxing on a warm and peaceful Sunday morning in July when 15-month-old Remi had an accident that changed the dynamic of her day and, to this day, her life.
“Remi was playing with one of those fan remotes; They are about the size of an egg. It fell to the ground and two of the button batteries popped out,” explained Megan Hulleman, Remi’s mother.
“Remi is really good at getting you things if you ask her. She brought me the batteries and I set them on the armrest of the couch. I picked her up, she grabbed her sippy cup, drank a little and then tossed the cup aside. As I went to get the sippy cup, she reached over and grabbed the batteries, and I heard her cough. Immediately I knew (what happened). My stomach just sank,” she added.
Megan knew immediately that Remi had swallowed a battery.
“The first thing I tried was to get it out with my finger. I couldn’t feel anything but she was coughing and you could see she was choking on something,” Hulleman said.
RJ and Megan rushed Remi to the ER in Orange City.
“As soon as they read the X-ray, they said, ‘No, we don’t do that here in Orange City. We are not prepared for this. We’re sending you to Sioux Falls.” We appreciated that at Orange City — we realized that this was outside of their wheelhouse,” Hulleman said.
Why swallowing a battery is an emergency
Patrick Munson, MD, is director of pediatric ear, nose and throat medicine at Sanford Health in Sioux Falls, South Dakota. He said Remi swallowed a disc or lithium battery. These types of batteries are typically the size of small coins or buttons.
dr Munson said if these types of batteries are swallowed, it’s imperative to remove them as soon as possible “because of the charge they have.”
“It can cause destruction and erode the tissue of the esophagus. So it’s really an emergency to get out,” he said. “We had her transferred to the children’s hospital, where she went straight to the operating room. Usually in these situations we have special endoscopes that we use to look down the esophagus and then we use a special grasping device to get it out,” added Dr. Munson added.
dr Munson tried and tried and tried, but he couldn’t grab the battery.
“I remember waiting in the waiting room and saying to RJ, ‘I know there’s a second battery at home.’ Well, 45 minutes later my stomach sank again. They said they were having trouble getting it out and wondered if there was a possibility of two batteries sticking together,” Hulleman said.
Expansion of Remi’s care team
Remi swallowed both batteries from the remote control. They were stacked on top of each other, making the esophagus so narrow that Dr. Munson couldn’t grab her. Knowing Remi would need more care, he called Adam Gorra, MD, a pediatric surgeon and pediatric trauma medical director at Sanford Children’s Hospital in Sioux Falls, South Dakota.
dr Gorra and Dr. Munson worked together and decided the best way to help Remi was to push the buttons in her stomach. Then they opened her stomach and pulled out the batteries.
“It was a unique situation. None of us had ever been in a scenario like this before. We had to improvise and do what we thought was best for the patient at the time,” said Dr. Gorra.
The two worked together for over four hours to get the batteries out.
“I couldn’t have done it without him. He wouldn’t have made it without me. I think we brought something special to the situation and that really benefited the patient,” said Dr. Gorra.
The Hullemans said Dr. Gorra and Dr. Munson would have made them feel like part of the care team.
“They came back and met us in the waiting room several times to update us on the state of affairs. They even drew pictures for us to show us what they were doing which was really nice. I think the biggest thing is that they kept reassuring us that they wanted to get the best result for Remi,” they said.
“I appreciate their patience and understanding for us. I think I sent about five My Sanford Chart messages in a weekend and they answered every one of them, which is huge,” they added.
path to recovery
Doctors successfully removed the batteries, but found that they caused a small hole in Remi’s esophagus while stuck in it. They fixed the hole knowing it would take Remi a while to fully recover.
Remi was hospitalized for two weeks before being told she could go home, albeit with severe dietary restrictions. She is currently still on a liquid diet to help her esophagus heal.
Part of recovery is slowly returning to solid foods. To do this, Remi had to come several times for endoscopy, an operation on a patient’s body and an expansion of her esophageal structure.
Essentially, Dr. Gorra draw esophagus slowly out. He can’t stretch it all at once, otherwise he might hurt Remi. Each time they perform this operation, the goal is to stretch it by two millimeters. Once they reach 10 millimeters, Remi can move on to full solid foods.
“I think we’re going to do this type of procedure two more times,” the Hullemans said.
Regardless of how long Remi’s recovery takes, the Hullemans said they were reassured knowing Remi was receiving the best possible care.
“We couldn’t have asked for a better team.”
Posted in Children, Otorhinolaryngology, Emergency Medicine, General Surgery, Specialty Care