Ingestions button batteries

• Button batteries lodged in the moist environment of the esophagus can cause a caustic injury: electrolytic reaction, leading to the formation of hydroxide radicals, which cause corrosion and tissue necrosis

• Serious burns may result within 2 hours of ingestion.

• High risk of caustic injury to adjacent structures (e.g., trachea, aortic arch)

• Caustic injury most commonly occurs in the esophagus; incidence of esophageal injury is highest in young children (due to smaller esophagus) and individuals with a history of esophageal disease.

• Possibly asymptomatic

• Drooling, vomiting

• Chest discomfort, dysphagia

• Mediastinitis

• Esophageal perforation

• History of witnessed or self-reported ingestion

• X-ray

  • AP view: Halo/double-rim effect

  • Lateral view: button batteries show a step-off effect due to the different size of the negative (smaller) and positive pole

• Emergency endoscopy (< 2 hours) is indicated in case:

  • Button batteries lodged in the esophagus

  • Button batteries located in the stomach/duodenal bulb if the patient is symptomatic

• Urgent endoscopy (< 24 hours) is indicated in case of:

  • Button battery located in the stomach/duodenal bulb in asymptomatic patients if

    • Age < 5 years, and/or size of the battery > 20 mm

    • Suspected coingestion of magnet

• Surgery is indicated in the following situations:

  • Esophageal impaction in a clinically unstable patient

  • Failed endoscopic removal

• Tracheoesophageal fistula

• Esophageal perforation

• Esophageal strictures

• Mediastinitis

• Vocal cord paralysis (recurrent laryngeal nerve injury)

Always consider the possibility that a button battery in children presenting with foreign body ingestion, esp. if parents report the ingestion of coins or similarly shaped objects.

Button batteries lodged in the esophagus can cause significant injury within hours of ingestion and should be removed immediately.