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Clinical Summary

The majority of button battery ingestions occur in children less than 6 years of age, peaking between age 1 and 2 years. The most important factors in determining symptoms at presentation, as well as management, are location within the GI tract and duration of contact with the mucosal surface. Batteries that are lodged in the esophagus may be asymptomatic initially or can present with pain, drooling, dysphagia, poor oral intake, cough, vomiting, or fever. Mechanisms of injury associated with button battery ingestion include liquefactive necrosis resulting from alkali exposure due to battery leakage or the de novo synthesis of alkali at the surface of the battery, electrical current–induced soft-tissue injury, and tissue pressure necrosis.

Management and Disposition

Anteroposterior and lateral plain radiographs should be obtained to locate the battery within the GI tract. Button batteries can be distinguished from coins on plain x-ray by demonstration of a double contour. Batteries that are lodged in the esophagus can lead to potentially fatal complications and require immediate removal in consultation with a gastroenterologist or surgeon. This is best accomplished with direct visualization via endoscopy. Batteries that are in the stomach should also be removed promptly. Once the battery is past the pylorus, x-rays can be repeated at weekly intervals in asymptomatic patients until passage is documented. Instructions detailing concerning symptoms (abdominal pain, abdominal distention, hematemesis, or blood in the stools) should be provided to the parents at the time of discharge.

Pearls

  1. Do not induce vomiting or attempt blind esophageal battery removal techniques.

  2. Serious esophageal burns can occur within 2 hours, and impaction for more than 12 hours increases the risk of perforation.

  3. Button batteries lodged in the nasal cavity or external auditory canal also require emergent removal to prevent complications such as perforation or stenosis.

FIGURE 14.98

Disk Battery Ingestion. Chest x-ray showing circular “coin-like” appearance with a second concentric ring from the plastic insulating grommet. This identifies the foreign body as a disk battery. (Photo contributor: Scott Manning, MD.)

FIGURE 14.99

Disk Battery. X-ray showing “step-off sign” and showing the narrow end of a button battery in the nasal cavity. (Photo contributor: Craig Folsom, MD.)

FIGURE 14.100

Disk Battery Ingestion. This endoscopic view shows esophageal necrosis after disk battery lodged in the esophagus. (Photo contributor: Scott Manning, MD.)

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