Button battery ingestion complications

Wallace, Bradley; Landman, Matthew P.; Prager, Jeremy D.; Kulungowski, Ann M.

doi:10.1016/j.epsc.2016.12.009

Cited by 13 publications

(12 citation statements)

References 15 publications

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“…Button batteries > 20 mm represent a greater risk for mucosa injury, as they have a higher voltage and can easily lodge in the esophagus ( 2 , 7 , 16 ). Using several databases, Litovitz et al ( 17 ) analyzed more than 60,000 cases of battery ingestions and noted that the specific battery most likely to cause serious sequelae was the ≥ 20 mm button battery, associated with 92.1% of major or fatal complications.…”

Section: Discussionmentioning

confidence: 99%

“…Despite perforation in our sample was more frequent in younger patients, this relationship was not statistically significant either. Unwitnessed ingestion is another well-known risk factor in complications ( 16 ). Despite almost all ingestions in our sample were witnessed ingestions (86%), all cases of unknown history of ingestion ( n = 5, 14%) had an esophageal location and presented with acute or chronic complications.…”

Section: Discussionmentioning

confidence: 99%

“…Late battery removal is another recognizably risk factor in complications ( 16 ). Although endoscopy was performed shortly after hospital admission in our sample, median time to battery removal in cases of EB was 7 h. Removal was performed later than recommended (≥ 6 h) in 80% of cases, as reported in other studies [with a median time from ingestion to removal of 6 h ( 5 , 25 )/7.5 h ( 29 ) and 8 h ( 30 )] and shorter than other case reports [with 17 h ( 6 ) and 36 h ( 31 )].…”

Section: Discussionmentioning

confidence: 99%

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Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center

et al. 2022

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IntroductionMorbidity related to childhood battery ingestions (BI) has increased recently due to the expanding use of larger lithium cells. A prompt endoscopic removal is vital to prevent severe complications in cases of esophageal batteries (EB).Materials and MethodsA retrospective, descriptive study of admissions for BI requiring endoscopic removal in a tertiary hospital's pediatric emergency department (Jan. 2011/Dec. 2020).ResultsWe had 35 cases, with an increasing incidence in the last 6 years; median age, 26 m (8 m-10 years), witnessed ingestion in 86%. On the X-ray: 14 (40%) had an EB, 21 (60%), a gastric battery (GB). Symptoms were present in 57% (100% EB/24% GB), and vomiting was the most frequent (50%). Endoscopy revealed: EB, 13 (37%); GB, 17 (49%); duodenal battery, 1 (3%); no battery, 4 (11%). Median time to removal: EB, 7 h (2 h-21days); GB, 12 h (2 h-3 days). All the patients with EB on the X-ray (14) had severe mucosal injury (Zargar classification): Grade IIIa, 7 (50%); IIIb, 5 (36%); IV, 2 (14%). CT-scan showed perforation in 2 patients (total, 4; 29% of EB). In patients with GB (21), 14 (67%) had mucosal damage; 13 (93%), mild (< Grade III, two esophageal erosions); 1 (7%) IIIa (esophageal ulceration). A statistically significant association between exposure time, younger age or battery size and severity of endoscopic lesions was found in EB location. There were no mortality cases. Acute complications occurred in 57% of EB: infection, 50%; perforation, 29%; pneumomediastinum/stridor, 14%; pneumothorax/subglottic stenosis/hemodynamic instability, 7 vs. 0% GB. Stenosis subsequently developed in 6 (43%) of EB: mild, 4 cases (29%); severe, 2 cases (14%, one resolved after endoscopic dilation; one needed a gastrostomy and esophagocoloplasty).ConclusionWe verified recent increase in admissions due to battery ingestions and associated complications, despite the availability of an emergency pediatric endoscopy team. The patients with EB had more severe mucosal injury and poorer short/long-term outcomes. Children with GB had milder lesions, although the presence of a GB did not exclude esophageal injury. The availability of actual data from national referral centers will support advocacy efforts among stakeholders, including industry representatives and policy makers, in preventing worldwide button battery injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center

et al. 2022

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“…Early multidisciplinary team (MDT) input must also be sought to adequately manage all potential complications. This often includes speech and language therapists, paediatrics, dietitians, ENT, and paediatric surgeons [12].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Vocal Cord Fibrosis: A Delayed Complication of Button Battery Ingestion

Banhidy¹,

Jamshaid²,

Ghedia³

et al. 2022

Cureus

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A 14-month-old girl initially presented to the Accident and Emergency (A&E) department following a choking episode and subsequent vomiting. The child left the department before being seen but re-presented the following morning with stridor, drooling, and increased work of breathing. A chest and lateral neck soft tissue X-ray performed in the A&E department revealed an ingested button battery in the oesophagus. Emergency oesophagoscopy was performed and a 22 mm button battery was removed from the oesophagus at the level of the cricopharyngeus muscle, with no immediate complications. Following extubation, the patient was initially well but later required a prolonged hospital stay due to recurrent episodes of stridor, voice changes and aspiration pneumonia. Follow-up microlaryngoscopy and laryngeal electromyography (EMG) diagnosed bilateral vocal cord palsy and cricoarytenoid fibrosis. This case highlights the need for increased public awareness, urgent diagnosis and standardised management of battery ingestion, and discusses the potential for the development of serious latent complications.

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“…Meticulous monitoring of the patient is necessary for adequate management of possible complications, both immediately following removal and after the patient is discharged. Necrosis is the most likely sequelae in the first week, followed by ulceration that could potentially result in perforation, and finally formation of strictures secondary to scar formation [ 16 ]. Patient presentation may not correlate with degree of damage, so follow-up imaging and endoscopy must be taken into consideration [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Evaluation for Stricture Formation Post Button Battery Ingestion

Bulna

Fifi

2021

Pediatric Reports

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Every year, there are over 3300 ingestions of button batteries, mostly by young children. Initial presentation of button battery ingestion may be nonspecific, with a delay in diagnosis and removal resulting in increased risk of complications. We present the case of a five-year-old female who presented with vomiting following unwitnessed button battery ingestion. The battery was impacted in the middle esophagus for at least six hours. Endoscopy was performed for immediate removal and showed a Grade 2B erosion, warranting nasogastric tube placement. The patient remained asymptomatic following discharge and had a barium swallow that was read as normal. However, a repeat endoscopy one month later visualized stricture formation at the previous battery injury site. This case highlights the importance of both clinician and parent awareness of button battery ingestion and demonstrates that endoscopy provides the most accurate assessment of esophageal injury and complication development, even in asymptomatic patients.

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Button battery ingestion complications

Cited by 13 publications

References 15 publications

Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center

Battery Ingestion in Children, an Ongoing Challenge: Recent Experience of a Tertiary Center

Bilateral Vocal Cord Fibrosis: A Delayed Complication of Button Battery Ingestion

Endoscopic Evaluation for Stricture Formation Post Button Battery Ingestion

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