Identifying predictive factors for long-term complications following button battery impactions: A case series and literature review

Eliason, Michael J.; Melzer, Jonathan M.; Winters, Jessica; Gallagher, Thomas Q.

doi:10.1016/j.ijporl.2016.06.016

Cited by 44 publications

(49 citation statements)

References 14 publications

(28 reference statements)

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“…This finding is in accordance with previous literature [3, 5, 10]. Animal studies have shown that necrosis of the lamina propria in the esophagus can develop within 15 min and can expand to the outer muscular layer of the esophagus within 30 min after button battery ingestion [13].…”

Section: Discussionsupporting

confidence: 93%

“…Animal studies have shown that necrosis of the lamina propria in the esophagus can develop within 15 min and can expand to the outer muscular layer of the esophagus within 30 min after button battery ingestion [13]. Serious complications after the ingestion of button batteries are described in children both with removal of the battery within a short period after ingestion (2–2.5 h) and with removal after a longer period (3 months) [3, 5, 10]. Even after removal, complications can still develop.…”

Section: Discussionmentioning

confidence: 99%

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Serious complications after button battery ingestion in children

et al. 2018

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Serious and fatal complications after button battery ingestion are increasing worldwide. The aim of this study is to describe serious complications after battery ingestion in children in the Netherlands.All pediatric gastroenterologists in the Netherlands performing upper endoscopies were asked to report all serious complications after battery ingestion in children (0–18 years) between 2008 and 2016 retrospectively.Sixteen serious complications were reported: death after massive bleeding through esophageal-aortal fistula (n = 1), esophageal-tracheal fistula (n = 5), stenosis after (suspected) perforation and mediastinitis (n = 5), (suspected) perforation and mediastinitis (n = 3), vocal cord paralysis (n = 1), and required reintubation for dyspnea and stridor (n = 1). The median time interval between ingestion and presentation was 5 (IQR 2–258) h. All children were ≤ 5 (median 1.4; IQR 0.9–2.1) years. Vomiting (31.3%), swallowing/feeding problems (31.3%), and fever (31.3%) were the most common presenting symptoms; however, 18.8% of the patients were asymptomatic (n = 1 missing). All batteries were button batteries (75% ≥ 20 mm; 18.8% < 20 mm; n = 1 missing). The batteries were removed by esophagogastroduodenoscopy (50%) and rigid endoscopy (37.5%) or surgically (12.5%).Conclusion: Sixteen serious complications occurred after small and large button batteries ingestion between 2008 and 2016 in both symptomatic and asymptomatic children in the Netherlands. Therefore, immediate intervention after (suspected) button battery ingestion is required. What is Known: • Button battery ingestion may result in serious and fatal complications. • Serious and fatal complications after button battery ingestion are increasing worldwide. What is New: • Sixteen serious complications after button battery ingestion occurred during 2008–2016 in children in the Netherlands. • Serious complications were also caused by small batteries (< 20 mm) in the Netherlands and also occurred in asymptomatic Dutch children.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Serious complications after button battery ingestion in children

et al. 2018

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“…The resultant damage could at times be fatal, depending on the site of lodgement 3. Among the various prognostic factors predicting long-term morbidity due to button battery insertion, ‘the time since impaction’ remains one of the important factor 5. Longer this charged foreign body stays in contact with a mucosal surface, larger is the surrounding tissue necrosis and higher is the probability of long-term morbidity or mortality.…”

Section: Discussionmentioning

confidence: 99%

Usual suspects: the foreign bodies of the aerodigestive tract

Devaraja¹,

Nayak

Bhandarkar

et al. 2018

BMJ Case Reports

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This case series is about four different foreign bodies lodged in different locations of the aerodigestive tract. All four cases had delayed diagnosis due to inconspicuous history. Radiology in the form of computed tomography aided the appropriate diagnosis in most of these cases. Though all four patients have been successfully managed by removal of foreign body, not all of them have identical outcomes. A brief discussion about predictive factors in the fish bone foreign body has been included. The authors also discuss certain critical aspects of the management, which may aid in reducing the morbidity. We emphasise on the high index of suspicion in peculiar cases and on the low threshold for radiological investigation in doubtful clinical scenarios.

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“…2,3 BBs impacted in the nasal cavity can cause complications, such as septal perforation, synechia, atrophy, necrosis, and saddle nose. [5][6][7][8][9][10][11][12] BBs also may cause periorbital cellulitis. 13 When the narrower negative poles of the BBs come into contact with the mucosa, they increase the pH by forming hydroxide ions in the tissue due to the electrical discharge.…”

Section: Introductionmentioning

confidence: 99%

“…This leads to tissue injury resulting from alkaline liquefactive necrosis, which is the pathogenesis mechanism responsible for complications. 5 Moreover, it has been suggested that this effect starts in as little as 2 hours. 14,15 In their esophageal models, Jatana et al investigated the basic mechanism of BB ingestion injuries and demonstrated the mitigation of BB-related alkali injuries with the neutralization strategies that they developed and had started to apply clinically to children.…”

Section: Introductionmentioning

confidence: 99%

Injury Mechanism of Button Batteries in the Nasal Cavity and Possible Mitigation Strategies During Impaction

2020

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Objective/Hypothesis Button batteries (BBs) impacted in the nasal cavity can cause several complications. Understanding the injury mechanism and developing possible mitigation strategies can reduce these complications. Study design Cadaveric sheep nasal septum model. Methods Lithium, alkaline, silver oxide, and zinc‐air BBs were placed on segments of the nasal septum of cadaveric sheep. The BB voltage, tissue temperatures, and pH were measured every 30 minutes for 6 hours. Subsequently, 5 drops of lemon juice, apple cider vinegar, tea, Coke (Coca‐Cola Co., Atlanta, GA), tap water, and normal saline were applied separately to the other segments with the lithium BBs every 10 minutes for 3 hours. The visible injuries and the necrosis depths were assessed through the tissue temperatures, pH, and the voltage changes. Results Both nonlithium and lithium BBs increased tissue pH without significant temperature changes. The 3V lithium BBs led to the greatest depth of necrosis, with a voltage loss of approximately 50% within the first 2 hours. Lemon juice and apple cider vinegar were the most effective liquids for reducing visible injury, pH, and necrosis without increasing the temperature during pre‐removal time period. Conclusion Nonlithium and lithium BBs caused alkaline tissue injury in a nasal septal model. Given the hazard severity, expedited BB removal is critical. For situations when removal cannot be immediately performed, further in vivo study is needed prior to considering human use of any pre‐removal mitigation strategies in the nasal cavity. Level of Evidence NA Laryngoscope, 130:2487–2493, 2020

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Identifying predictive factors for long-term complications following button battery impactions: A case series and literature review

Abstract: Based on case reviews, advancements in battery manufacturing, and laboratory research, there are distinct clinical factors that should be assessed at the time of initial therapy to guide follow-up management to minimize potential catastrophic sequelae of button battery ingestion.

Cited by 44 publications

References 14 publications

Serious complications after button battery ingestion in children

Serious complications after button battery ingestion in children

Usual suspects: the foreign bodies of the aerodigestive tract

Injury Mechanism of Button Batteries in the Nasal Cavity and Possible Mitigation Strategies During Impaction

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