Therapeutic dilemma and clinical issues in management of the button battery ingestion: a case report and literature review

The incidence of button battery ingestion in children less than 6 years, from year 1985 to 2019 was 59,000 and it is still a clinical challenge for pediatricians. Objects which are commonly ingested are large amounts of food, coins, toy parts, jewels, batteries, sharp materials and non-metallic sharp objects. It is an increased incidence of mortality and morbidity due to button battery ingestion, compared to accidental ingestion of other objects, due to its small size, and because of its potent source of energy. A literature search was carried out to evaluate the challenges in diagnosing, treatment, and follow-up of button battery ingested cases in children. A total of 36 original articles were included for the review.Conclusions: Button batteries can quickly cause severe damage to the mucosal lining of the GI tract. Esophageal button batteries require emergency removal because they can cause serious complications leading to hemorrhage, and death. In children, where the button battery has passed the esophagus watchful management should be made. In the majority of cases, the button batteries with a diameter less than 2 cm lodged in the stomach will pass spontaneously with no complications. However, asymptomatic children may be followed up with X-rays to assess progression up to 10–14 days after ingestion. Endoscopic or surgical removal may be required to prevent intestinal perforation with peritonitis. Symptomatic children will always need a consultation with a pediatric surgeon for surgery no matter where the button battery is placed in the GI tract. Developing countries shall adopt surveillance and reporting systems for BBI ingestion and related complications and it is recommended as essential to have management protocols in place for button batteries ingestion.

Survival of Toddler with Aortoesophageal Fistula after Button Battery Ingestion

Button batteries (BBs) are found in many households and are a source of esophageal foreign body in the pediatric population. Upon ingestion, significant caustic injury can occur within 2 hours leading to tissue damage and severe, potentially fatal sequelae. Aortoesophageal fistula (AEF) is a rare complication that nearly always results in mortality. We report a rare case of a toddler who developed an AEF after BB ingestion and survived following staged aortic repair. There should be a high index of suspicion for this complication with the history of BB ingestion and presence of hematemesis, hemoptysis, or melena.

Retrospective Study of the Round Radiopaque Foreign Bodies in the Oesophagus

Introduction Ingested foreign bodies (FBs) of the digestive tract can be divided into radiolucent and radiopaque, based on their appearance in Roentgenogram. Coins and button-batteries (BBs) constitute majority of the radiopaque FBs that are round in shape. Materials and Methods Medical records of children admitted with foreign bodies in the GI tract during the last 5 years have been reviewed. We have taken into our study, round radio-opaque FBs and analyzed the results. Results Out of 120 radiopaque FBs, in 112 cases they are lodged in cricopharyngeal sphincter (CPS), which were removed. Of these, 103 were coins and 9 were BBs. Five coins, which had crossed the CPS, ultimately passed out naturally with faeces. Three BBs, impacted in the oesophagus, distal to the CPS, were removed via esophagoscopy, on emergency basis. One child with impacted BB developed mediastinitis and died. Conclusion A round opaque disc shaped FB which is impacted or seen below CPS should not be treated as coin every time. High index of suspicion is needed to rule out BB ingestion as it is associated with high morbidity and mortality. Aim of this study is to stress on the need for educating primary care physicians and rural medical practitioners to avoid wait and watch policy, thus reducing misdiagnosis of coins for BBs.

To X-Ray or Not to X-Ray? Discussing Unknown Nasal Foreign Bodies and Button Batteries

The emergency of esophageal button batteries is recognized. Foreign bodies in the ear or nose are treated as comparatively nonemergent. We present the case of a child who presented with suspected pen-nib in the nostril to highlight the importance of investigation and intervention in unwitnessed nasal foreign body and review the literature regarding X-rays in these cases. Fifteen papers were identified as per search parameters; 3 papers recommend the use of plain radiographs for nasal foreign bodies. We propose that in unwitnessed pediatric nasal foreign body insertion, a facial X-ray should be considered, especially if suspecting a metallic foreign body.

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

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.