Button battery ingestion: An emerging pediatric epidemic

Abstract

Background : Button battery ingestion is emerging as a potential health problem of alarming proportions in young children. An increased usage in household electronics, easy accessibility to children and switch to durable but larger diameter higher voltage lithium batteries has resulted in increased morbidity and mortality over these past few years. Moreover, the symptoms of button battery ingestion are often non-specific and can lead to delay in diagnosis, especially in unwitnessed cases. Methods : This was a retrospective chart based review of all cases admitted with alleged history of button battery ingestion between 2016 to 2017. All such cases were identified and data regarding demographic, clinical, radiological and complications profile were recorded in a proforma and analyzed using standard statistics measures. Results : A total of 7 cases of button battery ingestion were included in the study. The mean age of patients was 1.6+0.9 years with 4 males and 3 females. Admission was within 24 hours of ingestion in 2 cases, between 2-5 days in 3 cases and beyond 1 month in 2 cases. The type of battery in all cases was lithium based. The common presenting symptoms were fever, cough, vomiting and refusal to feed (n=4 each) with two patients having drooling of saliva and 1 presenting with dysphonia. Five out of seven cases had witnessed ingestion while two were diagnosed radiographically. Prompt endoscopic removal was performed in all patients with most batteries lodged at level of cricopharynx (n=5). Major complications developed in 4 patients including tracheoesphageal fistula (n=4), aspiration pneumonitis (n=4), esophageal rupture (n=2), pleural effusion (n=2), pneumothorax (n=2) and mediastinitis (n=1). Three patients expired and four were discharged without sequelae. Conclusion : Early recognition and timely endoscopic removal is mandatory in cases of esophageal button battery ingestion. The prevention of serious injuries by creating physician and parent awareness regarding the hazardous effects of button battery is the need of the hour. Stringent rules and regulations regarding safer battery compartment designs, child resistant packaging and norms for discarding used lithium batteries would help in decreasing the incidence of this preventable epidemic.