From the Research
Endoscopic removal of a button battery from the duodenum should be performed immediately upon diagnosis, as it is an urgent medical procedure that can prevent life-threatening complications. The recommended approach involves upper endoscopy under general anesthesia with appropriate airway protection, as described in the study by 1. The endoscopist should use rat-tooth or alligator forceps to grasp the battery, with retrieval nets or snares as alternative options. Prior to removal, the battery's orientation should be assessed, and irrigation with saline may help visualize the area. Once grasped, the battery should be withdrawn carefully through the esophagus to prevent additional tissue damage.
Following removal, thorough inspection of the duodenal mucosa is essential to assess for tissue injury, ulceration, or perforation. Post-procedure care includes nil by mouth for 24 hours, proton pump inhibitors (such as omeprazole 20-40mg daily for adults or 1mg/kg/day for children), and close monitoring for delayed complications like strictures or fistulas. Button batteries are particularly dangerous due to their ability to generate hydroxide ions through tissue contact, causing rapid alkali burns and potential perforation within hours, as explained in the study by 2. The risk of serious injury increases with battery size (especially those ≥20mm), lithium composition, and longer exposure time, making rapid intervention critical to prevent life-threatening complications.
Some key points to consider in the management of button battery ingestion include:
- Immediate endoscopic removal is crucial, especially for batteries lodged in the esophagus or stomach, as highlighted in the study by 3.
- The use of honey and sucralfate may be considered in certain cases, but should not delay endoscopic removal, as noted in the study by 3.
- Gastric mucosal injury can occur within 10 hours of ingestion, and removal from the stomach should be considered earlier than 24 hours, as reported in the study by 1.
- Button batteries of 20-mm diameter need to be urgently removed from the esophagus and considered for removal earlier than 24 hours if in the stomach, as recommended in the study by 1.
Overall, the management of button battery ingestion requires prompt and careful attention to prevent serious complications and improve patient outcomes, as emphasized in the study by 4.