Serious complications after button battery ingestion in children

Hilde Krom,Tim De Meij,Anita M Van Den Neucker,Jessie M Hulst,Marc A Benninga,Hubert P J Van Der Doef,Margot J M Smit,Obbe F Norbruis,Angelika Kindermann,Victorien M Wolters,Margot Visser

doi:10.1007/s00431-018-3154-6

Abstract

Serious and fatal complications after button battery ingestion are increasing worldwide. The aim of this study is to describe serious complications after battery ingestion in children in the Netherlands.All pediatric gastroenterologists in the Netherlands performing upper endoscopies were asked to report all serious complications after battery ingestion in children (0–18 years) between 2008 and 2016 retrospectively.Sixteen serious complications were reported: death after massive bleeding through esophageal-aortal fistula (n = 1), esophageal-tracheal fistula (n = 5), stenosis after (suspected) perforation and mediastinitis (n = 5), (suspected) perforation and mediastinitis (n = 3), vocal cord paralysis (n = 1), and required reintubation for dyspnea and stridor (n = 1). The median time interval between ingestion and presentation was 5 (IQR 2–258) h. All children were ≤ 5 (median 1.4; IQR 0.9–2.1) years. Vomiting (31.3%), swallowing/feeding problems (31.3%), and fever (31.3%) were the most common presenting symptoms; however, 18.8% of the patients were asymptomatic (n = 1 missing). All batteries were button batteries (75% ≥ 20 mm; 18.8% < 20 mm; n = 1 missing). The batteries were removed by esophagogastroduodenoscopy (50%) and rigid endoscopy (37.5%) or surgically (12.5%).Conclusion: Sixteen serious complications occurred after small and large button batteries ingestion between 2008 and 2016 in both symptomatic and asymptomatic children in the Netherlands. Therefore, immediate intervention after (suspected) button battery ingestion is required.What is Known:• Button battery ingestion may result in serious and fatal complications.• Serious and fatal complications after button battery ingestion are increasing worldwide.What is New:• Sixteen serious complications after button battery ingestion occurred during 2008–2016 in children in the Netherlands.• Serious complications were also caused by small batteries (< 20 mm) in the Netherlands and also occurred in asymptomatic Dutch children.

Highlights

Children often put toys and other foreign bodies in their mouth and sometimes even swallow them
Serious complications were caused by small batteries (< 20 mm) in the Netherlands and occurred in asymptomatic Dutch children
16 cases of serious complications after button battery ingestion were reported by esophagogastroduodenoscopyperforming pediatricians from six tertiary care hospitals and two large regional general hospitals

Summary

Introduction

Children often put toys and other foreign bodies in their mouth and sometimes even swallow them. Older children with mental disabilities are at risk for foreign body ingestion. Small ingested foreign bodies pass the gastrointestinal tract spontaneously without complications. They can, cause serious damage especially when they get stuck in the esophagus [9, 14]. The number of serious complications and mortalities caused by button battery ingestions has been risen in recent years [11]. The most common symptoms after button battery ingestion are dysphagia, coughing, fever, and vomiting [2]. These symptoms are nonspecific and can be seen in many other diseases [7]

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