QUAD #3 Pt.2: Complications of Button Battery & Caustic Ingestion with Dr. Phil Putnam
With Dr. Phil Putnam · hosted by Dr. Kim Prippen · StayCurrentMD
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What the experts said
Presenting symptoms after button battery ingestion include pain, bleeding, dysphagia, feeding problems, sore throat, respiratory distress, and hoarseness.
The risk of developing complications from a button battery impaction in the esophagus is increased by the diameter of the battery, with newer batteries having higher voltage than previously.
The location of the impaction is crucial to whether there's going to be a through and through injury.
Batteries can be inserted as well as ingested, causing nasal septal perforation, intranasal injury, and tympanic membrane perforation from insertion in the ear.
GI tract complications include esophageal perforation or stenosis, gastric perforation, gastric outlet obstruction, and small intestinal perforation.
Early complications include pain, dysphagia, trouble feeding, trouble handling secretions, mediastinal soiling from perforation or leak, airway compromise, and fever.
Within weeks, there can be total healing or stricture formation.
In National Capital Poison Center data, 25 of the 62 reported battery ingestions were related to or caused by aortoesophageal fistulas.
The incidence of severe complications following a button battery ingestion has continued to significantly rise over the last 20 years.
An asymptomatic child with a witnessed ingestion deserves the same workup as a symptomatic child.
Nonverbal kids with abrupt onset of symptoms such as drooling or feeding problems should be worked up for foreign body ingestion.
The duration of symptoms for witnessed ingestions is usually pretty short, while unwitnessed ones can be days to weeks.
The mucosal electrochemical burn happens on the negative pole site of the battery.
There is pressure necrosis at the margins if a small child ingests a large battery and it doesn't get promptly removed.
Complications include TEF, lung hemorrhage, pulmonary stenosis, pneumonia, mediastinitis, and periorbital cellulitis.
Recovery after battery removal can take weeks to months.
While the initial mucosal injury may appear to heal well, complications can present within hours of removal, or in the case of strictures, may take weeks to develop.
A 2018 study from the Netherlands found that of the 16 most serious injuries from button battery ingestions between 2008 and 2016, all patients were under 5 years of age and the batteries were over 20 millimeters in size.
Kids are at greater risk for serious complications when the battery diameter is greater than 20 millimeters in size and ages are less than 5 years.
Button battery ingestions continue to have variable presentation and the potential to cause severe injuries or death.