A clinical report raises awareness of the frequency of button battery ingestion by children and the importance of immediate removal of batteries lodged in the esophagus.
In the September issue of Gastroenterology, Seung Han Kim et al describe the case of a 22-month-old child taken to the emergency room by his parents because of continuous drooling, irritability, and refusal to eat.
A plain chest radiograph revealed a disc-shaped metallic object in the upper esophagus, but no evidence of pneumomediastinum (see figure). An esophagogastroduodenoscopy (EGD) was performed and showed a 2-cm metallic object lodged in the esophagus, just below the upper esophageal sphincter (figure panel B).
This turned out to be a 2-cm, 3-volt lithium-ion button battery that had separated from a tympanic thermometer.
Kim et al say that in the United States, thousands of button battery ingestion cases are reported to poison control centers each year. Ingestion of button batteries does not cause many problems unless they become stuck in the digestive tract—commonly in the esophagus. They can damage tissue by generating current, leaking alkaline, and placing physical pressure on adjacent tissue.
Kim et al say that when button battery ingestion is suspected, a prompt plain film study can be used to verify ingestion and identify the location of the battery. A button battery stuck in the esophagus should be eliminated as soon as possible—preferably within 2 hours.
In this case, the patient was brought to the hospital almost 1 day after the symptoms appeared. The EGD showed severe adhesion between the esophageal mucosa and the button battery. With concern for esophageal perforation during retrieval of the battery, Kim et al removed the battery endoscopically, under general anesthesia.
No complications occurred, but a burn injury was seen by follow-up endoscopy. Seven days later, EGD showed a mild esophageal stricture, and a contrast esophagogram showed stenosis in the upper esophagus.
Kim et al say that it is important for physicians to be aware of the potential complications related to button battery ingestion. After retrieval of a battery from the esophagus, any mucosal damage must be monitored for later complications, such as tracheal stenosis, esophageal perforation, tracheoesophageal fistula, aortoesophageal fistula, or mediastinitis.