Unwitnessed lithium ion disc battery ingestion: case report and review of best practice management of an increasing clinical concern

Abstract

There is increasing concern regarding the acknowledged rising incidence of lithium ion disc battery ingestion. The lack of a high index of suspicion and the inability to recognise subtleties on imaging may lead to suboptimal management with a higher degree of unnecessary immediate and delayed morbidity. The recently published American Academy of Pediatrics Guidelines may guide the approach to managing battery ingestions.

Clinical Profile and Outcome of Esophageal Button Battery Ingestion in Children: An 8-Year Retrospective Case Series

“…The nonspecificity of the initial presentation is important, given that it has been included among the factors leading to a delayed diagnosis together with failure to detect the battery on an X-ray and lack of awareness of the seriousness of the condition by the initial care team [2, 21–23]. In addition, given that in nearly half of the cases in our series the ingestion event was unwitnessed, more than 50% of serious outcomes due to button battery ingestion likely occur after unwitnessed ingestion, due to the nonspecific character of the symptoms coupled with the high likelihood of a delay in recognition and diagnosis [14, 17].…”

Vascular ring complicates accidental button battery ingestion

“…Prompt radiographic recognition of a button battery by a double ring or halo sign and differentiation of it from a swallowed coin followed by emergent endoscopic removal have been emphasized in the literature and are considered a standard of care, as catastrophic complications may occur if diagnosis is delayed [4,7]. Significant esophageal injury following ingestion of a button battery may occur within 2 h and endoscopic removal constitutes a true emergency [4,10].…”

Emergent Treatment of Button Batteries in the Esophagus

“…9 Lack of this feature could indicate another type of foreign body, such as a coin. The double-shadow or "halo" effect is an easily recognized feature of button batteries on radiographs; however, its absence does not preclude the presence of a battery.…”

“…The double-shadow or “halo” effect is an easily recognized feature of button batteries on radiographs; however, its absence does not preclude the presence of a battery. 9 Lack of this feature could indicate another type of foreign body, such as a coin. However, as a button battery corrodes, it can lose its “halo” appearance, and this loss may be an ominous sign.…”

“…7 Esophageal injury occurs by flow of a direct current, and not by outflow of alkaline contents or compression. 9 In addition to retrieving the object, esophagoscopy allows direct inspection of the esophagus to determine the extent of injury and the presence or absence of esophageal perforation. 16 Esophagoscopy Endoscopy via rigid esophagoscopy is the foundation of removing esophageal button batteries.…”