From the Guidelines
Immediate medical attention is required for pediatric patients who have ingested batteries, particularly button batteries, due to the high risk of severe tissue damage and complications. The management of battery ingestion in pediatrics is guided by the principle of prompt removal to prevent further tissue damage. According to the World Journal of Emergency Surgery guidelines 1, emergent flexible endoscopy (preferably within 2 h, at latest within 6 h) is recommended for sharp-pointed objects, batteries, magnets, and for foreign bodies inducing complete esophageal obstruction.
Key considerations in the management of battery ingestion include:
- Prompt endoscopic removal of the battery, especially if it is lodged in the esophagus
- Monitoring for signs of esophageal obstruction, such as difficulty swallowing or respiratory distress
- Avoiding induction of vomiting or administration of food or drink
- Considering the use of honey (5-10 mL) every 10 minutes for children over 12 months of age to help neutralize the alkaline environment created by the battery, except in cases of airway compromise or known allergies
The severity of tissue damage from battery ingestion is related to the generation of hydroxide ions when the battery comes into contact with tissue fluids, creating a highly alkaline environment that causes liquefactive necrosis 1. Therefore, prompt removal of the battery is crucial to prevent long-term complications such as esophageal strictures, tracheoesophageal fistulas, or aortoesophageal fistulas. Post-removal care should include monitoring for delayed complications and providing supportive care as needed. Prevention through proper storage of batteries and battery-containing devices is also crucial to avoid these potentially life-threatening emergencies.
From the Research
Management of Battery Ingestion in Pediatrics
- The management of battery ingestion in pediatrics is a critical issue, with severe complications and even mortality possible if not addressed promptly 2, 3, 4, 5, 6.
- Immediate endoscopic removal is vital to prevent severe complications in cases of esophageal batteries (EB) 2, 3, 4, 5.
- The time to removal is crucial, with a median time to removal of 7 hours for EB and 12 hours for gastric batteries (GB) 2.
- Symptoms are present in 57% of cases, with vomiting being the most frequent symptom (50%) 2.
- Endoscopy revealed severe mucosal injury in all patients with EB, with 50% having Grade IIIa, 36% having Grade IIIb, and 14% having Grade IV injuries 2.
- CT-scan showed perforation in 2 patients (29% of EB) 2.
- In patients with GB, 67% had mucosal damage, but it was mostly mild (< Grade III) 2.
- A statistically significant association was found between exposure time, younger age, or battery size and severity of endoscopic lesions in EB location 2.
Prevention Strategies
- Prevention strategies are crucial to reduce the risk of battery ingestion in children 4, 6.
- Manufacturers should redesign household products to secure the battery compartment, possibly requiring a tool to open it 6.
- Parents and child care providers should be taught to prevent battery ingestions, including keeping batteries out of reach of children and ensuring that battery compartments are secure 6.
- Public awareness campaigns can also play a role in preventing battery ingestions 4.
Diagnosis and Management Algorithm
- An algorithm for the diagnosis and management of battery ingestions has been proposed, including immediate localization of the battery and removal if it is lodged in the esophagus 4.
- Honey and sucralfate can be considered in ingestions ≤12 hours while waiting for endoscopic removal, but should not delay it 4.
- In case of delayed diagnosis, a CT scan should be performed to evaluate for vascular injury before removing the battery 4.
- Asymptomatic patients with early diagnosis and position of the battery beyond the esophagus can be monitored with repeat X-ray in 7 to 14 days 4.