What happens if someone ingests a button battery?

Button Battery Ingestion Management

Button battery ingestion is a medical emergency requiring immediate intervention, as batteries lodged in the esophagus can cause severe tissue damage within 2 hours and potentially fatal complications including esophageal perforation, tracheoesophageal fistula, and aortoesophageal fistula. 1

Immediate Actions After Ingestion

1. Call poison control immediately (800-222-1222 in the US) 1
2. Obtain radiographs promptly (neck, chest, and abdomen) to confirm presence, location, and size of the battery 1, 2
3. For esophageal impaction:
   • Urgent endoscopic removal within 2 hours (maximum 6 hours) of ingestion 1, 3
   • While awaiting endoscopy (if ≤12 hours since ingestion), consider honey or sucralfate administration, but this should not delay removal 3

Removal Techniques

• Flexible endoscopy is first-line approach 1
• Rigid endoscopy may be considered as second-line for tight impaction, particularly in upper esophagus 1
• Combined techniques such as endoscopic balloon extraction with forceps retrieval may be needed for difficult cases 1

Post-Removal Management

1. Document mucosal damage and extent of esophageal burns 1
2. Consider nasogastric tube placement if significant erosion is found 1
3. For delayed diagnosis (>12 hours):
   • Perform CT scan to evaluate for vascular injury before removing the battery 3
   • Even if battery has passed the esophagus, consider endoscopy to assess esophageal damage and CT scan to rule out vascular injury, even in asymptomatic children 3
4. Follow-up endoscopy within 2-4 weeks to assess for stricture formation, even if asymptomatic 1
5. Obtain abdominal X-rays to confirm complete passage of the battery and check for retained fragments 1
6. Monitor for late complications including cadmium toxicity for at least 2-4 weeks after ingestion 1

Complications to Watch For

• Rapid tissue damage: Pressure necrosis, electrical burns, and chemical injury can occur quickly 1, 4
• Serious complications: Esophageal perforation, tracheoesophageal fistula, and potentially fatal aortoesophageal fistula 5, 6
• Delayed complications: Can occur even after battery removal, as demonstrated by a case where ascending aorta rupture occurred 13 days after battery removal 6

Important Considerations

• Mechanism of injury: Button batteries cause damage through four mechanisms: electrolyte leakage, alkali production from external currents, potential mercury toxicity, and pressure necrosis 7
• Symptom variability: Initial symptoms may be nonspecific including fussiness, decreased appetite, drooling, difficulty swallowing, hematemesis, or abdominal pain 4
• Contraindications:
  • Do not administer activated charcoal (ineffective and may complicate endoscopy) 1, 2
  • Avoid oral fluids (increases aspiration risk during endoscopy) 1
  • Do not use Foley catheter balloon technique for removal (may worsen injury) 1

Management Algorithm Based on Location

1. Esophageal impaction:

   • Emergency endoscopic removal within 2 hours 1, 3
   • CT scan if delayed diagnosis (>12 hours) 3

2. Beyond esophagus in asymptomatic patient:

   • With early diagnosis (≤12 hours): Monitor with repeat X-ray in 7-14 days if not already passed in stool 3
   • With delayed diagnosis (>12 hours): Consider endoscopy and CT scan even if asymptomatic 3

Button battery ingestion represents a true medical emergency with potential for catastrophic outcomes if not managed promptly and appropriately. The severity of tissue damage is time-dependent, making rapid identification and removal critical to preventing life-threatening complications.