Severe esophageal damage due to button battery ingestion: can it be prevented?

Abstract

Batteries represent less than 2% of foreign bodies ingested by children, but in the last 2 decades, the frequency has continuously increased. Most ingestions have an uneventful course, but those that lodge in the esophagus can lead to serious complications and even death. Medline was used to search the English medical literature, combining "button battery" and "esophageal burn" as keywords. Cases were studied for type, size, and source of the batteries; duration and location of the battery impaction in the esophagus; symptoms; damage caused by the battery; and outcome. Nineteen cases of esophageal damage have been reported since 1979. Batteries less than 15 mm in diameter almost never lodged in the esophagus. Only 3% of button batteries were larger than 20 mm but were responsible for the severe esophageal injuries in this series. These data suggest that manufacturers should replace large batteries with smaller ones and thus eliminate most of the complications. When the battery remains in the esophagus, endoscopic examination and removal done urgently will allow assessment of the esophageal damage, and treatment can be tailored accordingly. There is a need for more public education about the dangers of battery ingestion; this information should be included as part of the routine guidelines for childproofing the home.

Button batteries in the oesophagus: A surgical emergency

“…[4][5][6] Once the battery is in the restricted space of the oesophagus and in contact with its endothelium, which creates a circuit, it rapidly starts heating up, causing thermal cell damage. In addition, the casing erodes and leaks metals and hydroxide anions.…”

“…Oesophageal perforation can occur, [8] and the battery can then go on to erode into surrounding structures. The literature describes a wide range of complications, including aortooesophageal fistula, [9,10] which commonly presents as a herald bleed followed by a fatal upper gastrointestinal bleed, bilateral vocal cord paralysis, [9] tracheo-oesophageal fistula, [11] commonly presenting as aspiration pneumonia, oesophageal necrosis [6] and oesophageal stenosis. [5,6] …”

“…[13] In many cases, button battery ingestion may occur unnoticed, and children may be investigated after presenting with the symptoms of complications. These include abdominal pain, [6,9,14] respiratory symptoms such as distress and tachypnoea, [6] coughing, [9] wheezing or stridor, [10,13] and symptoms of oesophageal obstruction such as dysphagia, drooling [5,9] and vomiting. [2] Particularly omi nous is a history of haematemesis.…”

“…This approach is supported by the literature. [6,9,10,14] At the time of endoscopy, the oesophagus is assessed for evidence of injury (mucosal burns, necrosis or perforation), and further management is based on these findings. In the case of children who present with radiographic evidence of complications or who are severely ill, the child is stabilised from a respiratory and haemodynamic point of view, and then further imaging is undertaken before formulating a surgical plan.…”

Endoscopic management of ingested foreign bodies in children: A retrospective review of cases, and review of the literature

“…Esophageal necrosis, perforation, and death have been reported after button battery ingestion [17,26,28]. Although a large study found that mercury toxicity is rare [29], some batteries contain 5 g of mercuric oxide, which is a lethal dose. Lithium, manganese, and other heavy metals found in batteries do not cause toxicity [30,31].…”