Practical tips for paediatricians: Esophageal button battery impaction in children.

Abstract

Foreign body ingestion is a common reason for presentation to both outpatient paediatric as well as emergency medical care (1). Although the majority of esophageal foreign bodies are harmless, esophageal button batteries represent a special case where prompt recognition and removal is critical to avoid devastating complications and even death. Paediatricians and emergency room physicians play a central role in the timely management of button battery ingestion as most ingestions (70%) occur in children aged <6 years (2). The incidence of button battery ingestion associated with severe, life-altering injuries is on the rise (2). Over half of these ingestions are unwitnessed, and diagnosis is often delayed. Clinicians should have a high index of suspicion for a potential button battery if there is history of a ‘coin’ ingestion upon presentation. Although some children are initially asymptomatic, others may present with symptoms that mimic a viral infection including fever, decreased oral intake, vomiting, dysphagia, and cough (2). Clinicians must also watch for presenting symptoms of esophageal obstruction, including drooling and intraoral pooling of saliva (1). Potential complications of ingestion include esophageal perforation, tracheoesophageal fistula, major vessel injury, including aorto-esophageal fistula, vocal cord paralysis, and spondylodiscitis (3). An understanding of how to diagnose button battery ingestion and prevent or mitigate injury is critical to avoid these tragic consequences.