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

Abstract

Objective To present the clinical profile and outcomes of esophageal button battery ingestion cases treated at our institution over an 8-year period. Methods A total of 17 children who presented after ingesting a button battery and were treated at a tertiary care clinic over an 8-year period were included in this retrospective case series study. Data on patient demographics and esophageal location of the battery, time from ingestion to admission, symptoms, grade of mucosal injury, size of the battery, management, complications, and follow-up outcome were recorded. Results Median age was 29 months (range, 2–99 months). Boys comprised (n=11, 64.7%) of the study population. The most common location was the proximal esophagus (n=10, 58.8%). The median time from ingestion to admission was 6 h (range, 3–24 h). Hypersalivation alone (n=6, 35.3%) or together with vomiting (n=5, 29.4%) was the most common symptom. Grade IIA mucosal injury was noted in six (n=6, 35.3%) patients. The diameter of the battery was a median of 18.0 mm (range, 14–22 mm). We did not observe any correlation between the size of the battery and the grade of the injury. Early postoperative complications were encountered in one patient (n=1, 5.8%) and late postoperative complications were noted in eight patients (n=8, 47.1%) which required further esophageal dilatations, and follow-up revealed normal findings in eight patients (n=8, 47.1%) and mortality occurred in one patient. Conclusion The current case series study describing the clinical profiles and outcomes of 17 children who had ingested an esophageal button battery revealed male predominance, young patient age, and admission after a median of 6 h (3–24 h) of ingestion with nonspecific symptoms. Our findings confirm the success of rigid endoscopy to remove esophageal button batteries and indicate the likelihood of severe complications after removal.

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

“…The most frequent symptom in both EB and GB was vomiting (50%), followed by sialorrhea (30%), fever (20%), and refusal to eat and prostration (15%). These results are similar to what is reported in literature ( 5 , 13 , 19 , 20 ) and reflect the high number of cases in whom a later than recommended removal was performed, showing symptoms of potential complications. In patients with GB, two had esophageal lesions that could explain these symptoms (one patient with abdominal pain had a Grade IIa esophageal and gastric injury, and another one with vomiting and sialorrhea also had a Grade IIa esophageal lesion).…”

“…Battery ingestions are more frequent in small children, and associated complications are also more prevalent in children <5 years ( 7 , 9 ). In our study, the median age was 26 months, similar to what is reported in other series ( 5 , 6 , 18 ), and 75% of children were younger than 5 years. Despite perforation in our sample was more frequent in younger patients, this relationship was not statistically significant either.…”

“…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 )]. This later removal was due to late referral in 55% of cases, as most of the patients (89%) were referred from other centers; some of them remote and due to unknown history of ingestion in 45% (all of them with EB), as the patients went to the ED only after unspecific symptoms appeared.…”

“…Battery ingestions in children continue to rise due to a growing use of button batteries in household products ( 1 , 2 , 5 , 12 ). In our study, we also reported a growing incidence of battery ingestions in the last 6 years.…”

“…Although batteries may pass through the gastrointestinal tract uneventfully, they can cause severe or even fatal complications, especially in younger children if lodged in the esophagus ( 3 , 7 ). Mucosal damage starts as soon as 15 min after the ingestion, and severe damage can occur within 2 h ( 5 , 8 ); thus, a prompt endoscopic removal is the key to prevent serious complications in cases of esophageal batteries (EB) ( 3 ). In patients with gastric batteries (GB), management strategy remains controversial, and a differential approach has been advocated by the latest international guidelines of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition ( 8 ) and of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ( 9 ).…”