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Button Battery Ingestion
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Button battery ingestions are becoming more frequent, with national data showing increasing numbers of emergency department visits.
Button batteries are ubiquitous in greeting cards, remotes, and similar devices.
A ring around the edge of a circular object on X-ray indicates it is a button battery, not a quarter.
Foley catheter technique may work for button battery removal when operating room access is delayed and symptom duration is short.
NASPGHAN and the GI group developed guidelines for button battery management with zero input from surgeons.
Guidelines mandate serial MRIs for button battery cases due to concern for vascular injury.
20-25 millimeter batteries are lithium batteries that tend to be 3 volt rather than 1.5 volt.
The pathophysiology is caustic injury from hydroxide ions that rapidly raise tissue pH, not mechanical erosion or electricity.
Complications include esophageal perforation, stricture, tracheoesophageal fistula, and vocal cord paralysis not associated with perforation.
Using trauma one system activation reduced time from door to OR from 1.5 hours to less than 30 minutes.
For minor mucosal injury on endoscopy, symptomatic follow-up without intervention is appropriate.
For circumferential erosions that look bad, re-scoping to look for stricture formation is recommended.
If patients become symptomatic after injury, esophagram can assess for narrowing or stricture.
Endoscopy advantage over esophagram is ability to reassess appearance and dilate if needed.
If already performing endoscopy and capable of removing battery from stomach, removal is advocated.
20-25 millimeter batteries are the ones of most concern.
There is evolving work in animal models using 0.25% acetic acid applied to the area of injury to neutralize it.
Acetic acid for neutralization is not something off the shelf and requires pharmacy coordination.
The number of ED visits for button battery ingestion has doubled according to Colorado study data.
The rate of significant complications from button batteries has increased almost sevenfold.
90% of serious outcomes occur with 20-25 millimeter batteries.
Aortoenteric fistula is the most common cause of mortality in the national data bank, accounting for 46% of mortalities.
Another 29% of mortalities involved some sort of vascular compromise.
Aortoenteric fistula can occur up to 2 weeks post-removal of the battery.
Authors of the Colorado paper recommend MRI after battery removal to assess potential impact on surrounding vasculature.
Some authors advocate scoping patients even when battery is in the stomach because patients can have significant esophageal injuries with the battery having passed on.
Poison.gov recommendations say you do not need to scope if the battery is in the stomach.
There is GI literature about removing 20 millimeter batteries from stomach because they may not pass the ileocecal valve.