From the Guidelines
The most appropriate next step is immediate endoscopic removal of the button battery. The radiograph shows a button battery in the esophagus, which constitutes a medical emergency requiring prompt intervention, as emphasized by the World Journal of Emergency Surgery guidelines 1. Button batteries can cause severe tissue damage through direct electrical current, pressure necrosis, and leakage of alkaline contents, potentially leading to esophageal perforation, tracheoesophageal fistula, or major vessel erosion within hours of ingestion.
The guidelines recommend emergent flexible endoscopy (preferably within 2 h, at latest within 6 h) for button/disk battery ingestion due to the risk of pressure necrosis, electrical burns, and chemical injury 1. The child should be kept NPO (nothing by mouth) and immediately transferred to a facility capable of performing endoscopic removal if not available at the current location. While the child appears asymptomatic now, this is deceptive as significant tissue damage can occur silently.
Some key considerations in the management of this case include:
- The need for prompt intervention to prevent serious complications
- The importance of keeping the child NPO to minimize the risk of further injury
- The potential role of honey in neutralizing the alkaline environment if endoscopy is delayed, although this should not delay definitive removal
- The need for close monitoring and follow-up imaging after removal to assess for complications
Waiting for spontaneous passage or attempting induced vomiting are contraindicated due to the high risk of serious complications from esophageal impaction, as highlighted by the guidelines 1. The priority is to minimize morbidity, mortality, and improve the quality of life for the child, which is best achieved through immediate endoscopic removal of the button battery.
From the Research
Assessment and Management of Esophageal Foreign Bodies
The child has ingested a button battery from a travel alarm clock, and a radiograph has been taken. The most appropriate next step is to assess the patient's airway and consider endoscopy as the intervention of choice 2.
Key Considerations
- The patient is currently in no distress, and the physical examination is unremarkable, but this can change rapidly in cases of esophageal foreign bodies or obstruction.
- The presence of a button battery in the esophagus is a medical emergency that requires prompt attention to prevent serious complications such as esophageal perforation or obstruction.
- Endoscopy is the preferred method for removing esophageal foreign bodies, and early endoscopy for complete obstruction is associated with improved outcomes 2.
Potential Complications
- Esophageal perforation is a serious and potentially life-threatening medical emergency that requires prompt diagnosis and treatment 3, 4.
- The use of corticosteroids may be beneficial in preventing strictures in patients with second- or third-degree corrosive esophageal burns, but its use in other cases of esophageal foreign bodies or obstruction is not well established 5.
Next Steps
- The patient should be closely monitored for signs of esophageal perforation or obstruction, and endoscopy should be performed as soon as possible to remove the button battery.
- The patient's airway should be assessed, and measures should be taken to support the respiratory system if necessary.
- Broad-spectrum antibiotics may be considered to prevent infection, especially if there is a risk of esophageal perforation 3, 4.