Button Battery Ingestion Management
For button battery ingestion in pediatric patients, emergent endoscopic removal within 2 hours (at latest within 6 hours) is mandatory for esophageal impaction due to the high risk of pressure necrosis, electrical burns, and chemical injury that can occur rapidly. 1
Immediate Actions Upon Presentation
Activate Emergency Protocol
- Activate emergency medical services immediately if esophageal impaction is suspected 1
- Do not delay for any reason—tissue damage can occur in as little as 2 hours 1, 2
- Maintain high index of suspicion even with nonspecific symptoms (fussiness, decreased appetite, drooling, difficulty swallowing, hematemesis, or abdominal pain) 2
Diagnostic Imaging - Do Not Delay
- Obtain plain radiographs immediately to document and localize the battery 1, 3, 4
- For delayed diagnosis (>12 hours after ingestion) with esophageal impaction, perform CT scan before removal to evaluate for vascular injury 3
- CT scan has 90-100% sensitivity compared to only 32% for plain x-rays and should be used when perforation or complications are suspected 1
Risk Stratification Based on Location
Esophageal Impaction (HIGHEST RISK)
- Emergent endoscopic removal within 2 hours is mandatory, regardless of symptoms 1, 3
- The battery creates a local tissue pH of 10-13 causing liquefactive necrosis at the negative pole 5
- Electrochemical burns, pressure necrosis, and chemical injury occur rapidly 1, 3
Pre-Removal Mitigation (Only if Removal Will Be Delayed)
- Administer honey (in children >1 year) or sucralfate if ingestion is <12 hours old and removal will be delayed 1, 3
- This should NOT delay endoscopic removal 1, 3
- Consider intraoperative irrigation with acetic acid during removal 5
Beyond the Esophagus (Lower Risk)
- For batteries that have passed beyond the esophagus in asymptomatic patients with early diagnosis (≤12 hours), monitor with repeat X-ray in 7-14 days to confirm passage in stool 3
- However, in delayed diagnosis (>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
Critical Pitfalls to Avoid
Do NOT:
- Do not administer water or milk to dilute the ingestion 1
- Do not induce vomiting 1
- Do not administer activated charcoal 1
- Do not delay endoscopic removal for batteries lodged in the esophagus 1
- Do not rely solely on symptoms—initial presentation may be vague and similar to viral illness 5
Post-Removal Monitoring
Delayed Complications Surveillance
- Carefully monitor for potential delayed complications including tracheoesophageal fistula, esophageal stenosis, and fistulization into major vessels (often fatal) 6, 5
- These complications can develop even after successful removal due to progressive tissue breakdown 5
- Extensive follow-up care is essential, as demonstrated by cases requiring management of fistulas and stenosis 6
Key Differences from Other Foreign Bodies
Button batteries are uniquely dangerous compared to other ingested foreign bodies due to three mechanisms: electrical current generation causing burns, pressure necrosis from impaction, and release of caustic substances (creating pH 10-13 environment) 1, 4, 5. This triple threat explains why the 2-hour window is critical and why conservative management is never appropriate for esophageal impaction 1, 3.