Button Battery Ingestion

Button battery ingestions are becoming more frequent, with national data suggesting increasing numbers of emergency department visits.

A radiographic ring around the edge of a circular object on X-ray indicates a button battery rather than a quarter.

The Foley catheter technique may work for button battery removal in limited situations when the operating room cannot be accessed quickly and there is short duration of symptoms without likely perforation.

NASPA and the GI group put together criteria and guidelines around management of button batteries with zero input from surgeons.

The guidelines mandate multiple MRIs and watching these patients because of concern for vascular injury.

The number of ED visits for button battery ingestion has doubled according to data from Colorado.

The rate of significant complications from button battery ingestion has increased almost sevenfold.

90% of serious outcomes from button battery ingestion occur with 20 millimeter to 25 millimeter batteries.

The problematic batteries are lithium batteries that tend to be 3 volt batteries as opposed to 1.5 volt batteries.

The pathophysiology of button battery injury is caustic injury from hydroxide ions that rapidly raise the pH in tissue, not erosion of the battery itself or electricity.

Complications of button battery ingestion include esophageal perforation, stricture, tracheoesophageal fistula, vocal cord paralysis not associated with perforation, and aortoenteric fistula.

Aortoenteric fistula is the most common cause of mortality in button battery ingestion, accounting for 46% of mortalities in the national data bank.

Vascular compromise was identified as the etiology in another 29% of mortalities from button battery ingestion.

Aortoenteric fistula from button battery ingestion can happen up to 2 weeks post removal of the battery.

A trauma one activation system for button battery ingestions reduced time from hitting the door to hitting the OR from 1.5 hours to less than 30 minutes.

The recommendation to scope patients when the battery is in the stomach completely flies in the face of actual recommendations from poison.gov, which say you do not need to do that.

For relatively minor mucosal injury from button battery, no intervention is needed and symptomatic follow-up is appropriate.

For circumferential erosions that look bad from button battery injury, re-scoping to look for stricture formation is appropriate.

If a patient becomes symptomatic after button battery removal, an esophagram should be done to see if they have narrowing or stricture.

If performing endoscopy and capable of removing a battery from the stomach endoscopically, removal is advocated because you are already there.

There is evolving work in animal models using 0.25% acetic acid applied to the area of injury to neutralize caustic damage from button batteries.