What is the management for button battery ingestion?

Management of Button Battery Ingestion

Immediate endoscopic removal (within 2 hours, maximum 6 hours) is mandatory for button batteries impacted in the esophagus due to the high risk of pressure necrosis, electrical burns, and chemical injuries that can lead to life-threatening complications. 1

Initial Evaluation

• Radiographic assessment:

  • Obtain plain radiographs (X-rays) of the neck, thorax, and abdomen to confirm:
    • Presence and exact location of the battery
    • Size and form of the battery
    • Number of batteries ingested
    • Signs of possible complications 1
  • CT scan should be performed if there is suspicion of perforation or other complications 1

• Do not delay intervention for contrast studies as these may delay critical treatment 1

Management Algorithm Based on Location and Timing

Esophageal Impaction

1. Early diagnosis (≤12 hours):

   • Immediate endoscopic removal (preferably within 2 hours, maximum 6 hours) 1, 2
   • While awaiting endoscopy (but not delaying it):
     • Consider administering honey or sucralfate if ingestion occurred ≤12 hours ago 2

2. Delayed diagnosis (>12 hours):

   • Perform CT scan to evaluate for vascular injury before removing the battery 2
   • Proceed with endoscopic removal
   • Consider screening for esophageal damage and vascular injury even in asymptomatic children 2

Beyond Esophagus (Stomach or Intestine)

1. Early diagnosis (≤12 hours) and asymptomatic:

   • Monitor with repeat X-ray in 7-14 days if not already evacuated in stool 2
   • Provide clear return precautions to caregivers 1

2. Delayed diagnosis or symptomatic:

   • Consider endoscopy to screen for esophageal damage
   • Consider CT scan to rule out vascular injury even in asymptomatic children 2

Monitoring for Complications

• Monitor for late complications for at least 2-4 weeks after ingestion, even if the battery has been eliminated 1
• Watch for signs of:
  • Delayed esophageal perforations
  • Fistula formation (tracheo-esophageal or aorto-esophageal)
  • Massive hemorrhage
  • Cadmium toxicity (if battery casing was compromised) 1, 3

Special Considerations

• Timing is critical: Caustic injury can occur within 2 hours of exposure 4
• High index of suspicion: Initial symptoms may be vague and nonspecific (fussiness, decreased appetite, drooling, difficulty swallowing, hematemesis, abdominal pain) 5
• Surgical intervention: Required in cases of irretrievable foreign body, perforation, proximity to vital structures (aortic arch), or other complications (1-3% of cases) 6
• Multidisciplinary approach: Involve emergency physicians, gastroenterologists, otolaryngologists, and surgeons as needed 4

Prevention Strategies

• Educate caregivers about the dangers of button batteries
• Advocate for child-resistant packaging and warning labels
• Promote proper disposal of used batteries
• Encourage reporting of button battery injuries through the Global Injury Research Collaborative 4

Button battery ingestion represents a true emergency when impacted in the esophagus, with potential for life-threatening complications including tracheo-esophageal and aorto-esophageal fistulas. The mortality and morbidity can be significantly reduced with prompt diagnosis and appropriate management.