Endoscopic Retrieval vs Observation in Cylindrical Battery Ingestion

Abstract

Background: Battery ingestion, particularly in the pediatric population, has become more common since the development of button batteries. Consequently, formal recommendations regarding the management of this battery type have been developed. Larger cylindrical battery ingestion is less common, with fewer cases reported. As such, no clear practice guidelines have been developed for the management of cylindrical battery ingestion. Case Report: We present a case of an incarcerated adult who ingested 2 AA batteries. One battery was retrieved endoscopically, but the second passed into the distal small bowel beyond endoscopic means of retrieval. The second battery passed spontaneously via the rectum after administration of laxatives and supportive care. Conclusion: Our case and review of the literature demonstrate that nonsurgical, conservative management with close clinical monitoring is possible in a hospital setting after cylindrical battery ingestion. Cases with concerning clinical symptoms or a history of damage to the battery casing warrant endoscopic or surgical intervention.

Ingestion of Cylindrical Battery and Medical Treatment

“…According to Hammami MB et al, for the patient who ingested two AA batteries, endoscopic removal was applied for the battery which was in the stomach, whereas for the one which passed to the duodenum a daily medical treatment with 17g polyethylene glycol 3350 pro-kinetic agent was applied and the patient ejected the second battery at the seventh day by defacation. 8 In our case, with no oesophageal obstruction, although he had laparotomy previously, we chose medical treatment method as the cylindrical AA battery remained in the stomach for less than 1 day.…”

Endoscopic Removal of Multiple Ingested Cylindrical Batteries

“…In other previous reports, a cylindrical battery that had moved beyond the pyloric ring into the small intestine was surgically removed, although, in recent years, most of the cases were followed up with the expectation of spontaneous elimination [5][6][7]. Hammami et al reviewed 15 cases and one case series of cylindrical battery ingestion and reported that no major complications occurred in asymptomatic cases at initial presentation, despite choosing conservative management [10]. Therefore, it is suggested that conservative management with close clinical monitoring might be possible if the patient is asymptomatic and the ingested battery cannot be seen by EGD.…”

“…Litovitz et al reported that of 8,648 cases of battery ingestion from 1990 to 2008 in the United States, 8,161 (94.4%) involved a button battery and 487 (5.6%) were cylindrical batteries [ 8 ]. Most cases of accidental ingestion of a button battery occur in children [ 9 ], whereas ingestion of a cylindrical battery is seen more commonly due to deliberate ingestion in a psychiatric population and by prisoners [ 10 ]. Our patient also had mental retardation as the underlying disease.…”

Intentional ingestion of batteries and razor blades by a prisoner: a true emergency?

“…When ingested, cylindrical batteries can cause corrosive damage to the mucosal lining of the gastrointestinal tract (GIT), if their casing is damaged either by the acidic gastric content or deliberately prior to ingestion. If leakage occurs, patients will usually be symptomatic or have corrosive damage of the mucosa in endoscopy (Hammami et al , 2019). Furthermore, alkaline batteries contain metals including zinc, manganese, potassium hydroxide, mercury and an alkaline electrolyte solution that can cause liquefaction necrosis, erosions, ulceration and perforation, metal toxicity and hypersensitivity.…”