Urgency of Esophageal Foreign Body Removal: Differentiation Between Coins and Button Cell Batteries

Abstract

Objective Coin-shaped button battery foreign bodies have a similar initial presentation to coin ingestion, but delayed retrieval of a battery from the esophagus can have devastating consequences. Variations in timing of retrieval for children with ingestion of coin foreign bodies have been reported. The study assesses the sensitivity and specificity of conventional and digital radiographs to differentiate button batteries from coin foreign bodies. Study Design 3B case control study. Study Setting Tertiary academic medical center. Methods A radiographic study of the 12 most common commercially available button batteries and 66 coins of varying international origins was performed. Foreign bodies were placed at the cervical esophagus of a cadaver, and anteroposterior (AP) and lateral conventional radiographs of the neck were obtained. Digital AP and lateral radiographs of standalone coins and batteries were also obtained. Images were blindly read by 2 otolaryngologists and 2 radiologists. Statistical analysis was performed to determine accuracy in identifying coins vs batteries. Results Using conventional radiographs to identify button batteries yielded a sensitivity of 0.88 and a specificity of 0.92 (positive predictive value [PPV] = 0.75, negative predictive value [NPV] = 0.97). Digital radiography yielded an overall sensitivity of 0.98 and specificity of 0.97 (PPV = 0.87, NPV = 0.99). Features of button batteries were only seen on AP conventional radiographs using reverse contrast. Conclusions Neither conventional nor digital radiographic imaging had perfect accuracy in identifying coins vs batteries. Features of common disc batteries were identified, which may aid in diagnosis. With potential devastating consequences from retained battery in the esophagus, emergent removal of any possible disc battery foreign body should be considered.

Two Stacked Coins Mimicking an Esophageal Button Battery: A Case Presentation and Review of the Literature

“…For patients with an FBI, the standard of practice is to order both anterior-posterior and lateral radiographs. The step-off and differences in height between the positive and negative nodes of the cell give BBs their two most characteristic features: on AP view, a "double-halo sign" around the outer region of the disc, and a raised center portion on lateral view [1,3]. Radiographs may have a strong negative predictive value of BB ingestion, especially when coupled with a negative medical history [5].…”

“…Radiographs may have a strong negative predictive value of BB ingestion, especially when coupled with a negative medical history [5]. Due to the variety of BBs available on the market, not all BBs have easily distinguishable double-halos on radiographs due to differences in sizing dimensions and step-off effect [1,6]. Various methods have been developed to aid quick and accurate diagnosis, although with limited success.…”

“…Foreign body ingestion (FBI) is common in the pediatric emergency setting, with coins responsible for 60-85% of cases [1]. With at least 40% of all pediatric FBIs being unwitnessed, clinicians are heavily reliant on a good history and imaging studies to identify the foreign body [2].…”

“…They appear similar to coins on radiographic imaging. BBs make up to 2% of pediatric FBIs, and there has been a significant increase in morbidity and mortality due to their ingestion in the past two decades [1,3]. Children younger than five are at the greatest risk of severe injury due to BB ingestion, making any suspected ingestion a prioritized emergency.…”

Secondary esophageal perforation rupture of ascending aorta 16 day accidently-swallowing button battery in a young child: A case report of esophagial foreign body and mini review

“…Anatomically, more than 95% of cases occur at the first stenosis, but the prognosis is relatively good. Although it is rare to occur at the second stenosis, it often results in fatal complications [8] , [9] .…”