Cylindrical Battery Ingestion: Emergent Endoscopic Retrieval or Patient Observation? A Case Report and Literature Review

Abstract

Battery ingestion, particularly in the pediatric population, has become more common since the development of button-shaped batteries. Consequently, formal recommendations regarding management of this battery type have been developed. However, larger, cylindrical battery (CB) ingestion is less common, with fewer cases reported. As such, there are no clear guidelines regarding its management. We present a case of an adult prison inmate who ingested two AA batteries in a suicide attempt. One battery was retrieved endoscopically (Figure 1) & the other with a laxative & supportive care (Figure 2). In our review, we found that most reported patients who had ingested CB remained asymptotic & if present, symptoms usually manifested as upper GI complaints or abd pain. However, there have been unusual presentations such as ST-segment abnormalities on ECG & a grand-mal seizure reported. Other than in one patient, all patients with history of prior abd surgery required either surgical or endoscopic intervention for battery retrieval. Otherwise, several cases demonstrated spontaneous passage of the ingested CB by rectum as demonstrated by the largest case series by Hindley et al. On the other hand, we found that in all cases (except for one) where there was evidence of corrosive changes, leakage or damage to the battery casing, patients were symptomatic or had evidence of mucosal damage. It would appear, both from our experience & reviewed literature, that CB swallowing not accompanied by abd symptoms or history of encasement defect before ingestion can be managed conservatively and with the aid of radiologic imaging. In accordance with current guidelines, we propose that if there is no history or evidence of encasement defect, absence of symptoms or abnormal physical exam findings, & as long as the batteries are confirmed to be beyond the esophagus, then CB ingestion should be managed conservatively. Non-urgent EGD may be considered if the batteries remain within reach of an endoscope. Clinical monitoring & following battery progression through the GI tract with serial abdominal radiographs until batteries are discharged by rectum should be achieved. However, it should be emphasized that in the presence of prior abdominal surgery, history or evidence of damage to the battery, or any clinical symptoms should prompt urgent endoscopy & battery retrieval or surgical consultation if the batteries are beyond endoscopic reach.Figure: Endoscopic image in retro flexion revealing one ingested battery in the gastric fundus.Figure: Anterior posterior supine views of the abdomen demonstrating the single ingested cylindrical structure advancing through the GI tract C. Within the RLQ and either in the distal ileum or proximal colon D. Within the region of the ascending colon E. Within the region of the ascending colon F. Within the left mid abdomen and in the region of the descending colon G. Within the region of the sigmoid colon H. Projects over the pelvis in the region of the rectum (Hospitalization day 2,3,4,5, 6, & 7)Table: No Caption available