Treatment for Button Battery Ingestion
For button batteries lodged in the esophagus, emergent endoscopic removal within 2 hours (at latest within 6 hours) is mandatory due to the high risk of pressure necrosis, electrical burns, and liquefactive necrosis that can occur rapidly. 1, 2
Immediate Actions Upon Suspected Ingestion
Diagnostic Imaging
- Obtain plain radiographs (neck, chest, abdomen) immediately to locate the battery position 1
- Biplanar radiography helps differentiate esophageal from tracheobronchial location 1
- CT scan should be performed if ingestion occurred >12 hours ago with esophageal impaction to evaluate for vascular injury before removal 3
- CT scan is also indicated for suspected complications (perforation, mediastinitis, aortic/tracheal fistulas) 1
Pre-Removal Mitigation Strategies
- Administer honey (in children >1 year old) or sucralfate if ingestion is <12 hours old and removal will be delayed, but do not let this delay endoscopy 2
- Do NOT induce vomiting 2
- Do NOT administer activated charcoal 2
- Do NOT give water or milk 2
- Nothing by mouth except the honey/sucralfate mentioned above 2
Endoscopic Removal Protocol
Timing Based on Location
Esophageal Location:
- Emergent removal within 2 hours (maximum 6 hours) regardless of symptoms 1, 2
- Tissue damage from liquefactive necrosis begins within 2 hours due to local pH of 10-13 at the negative pole 4
- General anesthesia with endotracheal intubation is typically required for airway protection 1
Gastric or Beyond:
- For asymptomatic patients with early diagnosis (≤12 hours) and battery beyond the esophagus, monitor with repeat X-ray in 7-14 days 3
- However, gastric batteries can cause mucosal erosion within hours, so urgent removal should be considered even in asymptomatic patients, particularly for larger batteries (≥20mm) 5
- Symptomatic patients require urgent endoscopic removal regardless of location 3
Endoscopic Techniques
- Gentle retrieval using baskets, snares, or grasping forceps 1
- For impacted batteries, consider balloon catheter technique: pass catheter beyond the battery, inflate balloon, and withdraw to disimpact 1
- Novel combined approach using endoscopic balloon extraction with forceps retrieval creates push-pull synergy for difficult cases 6
- Intraoperative irrigation with acetic acid may be considered 4
Post-Removal Management
Delayed Diagnosis Cases (>12 hours)
- Even if the battery has passed the esophagus, perform endoscopy to screen for esophageal damage and CT scan to rule out vascular injury, even in asymptomatic children 3
- This differs from early diagnosis cases and reflects the progressive nature of tissue injury 3
Follow-Up Monitoring
- Careful consideration for delayed complications including tracheoesophageal fistula and aortoesophageal fistula, which can be fatal 4, 7
- Esophageal stenosis may develop in cases with significant burns 7
- Follow-up endoscopy should be performed to assess healing and detect complications 6
Critical Pitfalls to Avoid
- Do not delay endoscopic removal for esophageal batteries—tissue damage occurs within 2 hours 2
- Do not perform contrast swallow studies as they increase aspiration risk with complete obstruction and barium can coat the battery, impairing visualization 1
- Do not assume gastric location is safe—multiple gastric erosions can develop within hours 5
- Do not miss delayed presentations with vague viral-like symptoms, as patients may not have witnessed ingestion history 4