Battery Ingestion Research Articles

Application of a double-balloon method to remove button battery at the entrance of esophagus in a 17-month-old child: a case report

BackgroundSince children have strong desire for exploration and poor safety awareness, foreign body impaction in the digestive tract is one of the most common critical conditions in children. Due to the popularity of electronic products, button battery ingestion by mistake is also increasing in children. Button battery impaction in the esophagus can cause serious complications such as esophageal cauterization and perforation in a short time. Therefore, more active treatment strategies should be taken once button battery ingestion occurs. Surgical treatment is traumatic and prone to cause various complications, so removal of foreign body retained in the esophagus under endoscopy is the preferred strategy.Case presentationWe introduced a new method to remove the button battery retained in the esophagus of a 17-month-old child. Soon after the patient arrived at the hospital, we actively arranged endoscopic surgery. After the gastroscope entered the esophageal inlet, we first cleaned up the esophageal residues, and then, the button battery was exposed. The surrounding esophageal mucosa showed a little cauterization-like damage. We tried to remove the foreign body using foreign body forceps first, but failed after repeated attempts. Then, we tried to use a disposable balloon to assist in dragging the foreign body, but because the patient was younger with narrower esophagus and the drag resistance of the foreign body was abnormally large, this method also did not work. Violent dragging may cause tearing and perforation of the esophagus. Hence, we used a columnar balloon to help expand the esophagus and successfully removed the button battery at the entrance of the esophagus. For this new method, the columnar balloon was used to expand the esophagus and the button battery was clamped with foreign body forceps, and then, the foreign body was dragged by a disposable stone removal balloon. Because two types of balloons were used, it was named double-balloon method.ConclusionsFor the foreign body retained in the esophagus of younger children, the double -balloon method is recommended when the foreign body cannot be removed by traditional methods.

Preventing battery ingestion in children: public health strategies and technological innovations

Abstract Background Accidental ingestion of button batteries can cause severe and sometimes fatal injuries, such as chemical burns, esophageal perforations, and long-term complications. In response to this challenge, prevention strategies have evolved. A recent example of safety-targeted technological innovation includes new coin lithium batteries with more secure packaging, a non-toxic bitter coating to deter ingestion, and a ‘color alert technology’ that activates a blue dye upon contact with saliva. These features are designed to discourage ingestion and facilitate the rapid identification of an injury, allowing for timely medical intervention. Methods This abstract reviews the public health strategies proposed or implemented to prevent this serious type of injury, augmented by an analysis of data from the Susy Safe registry, which identified 1,115 cases of battery ingestion in children, and an additional 94 cases from the literature, totaling 1,209 injuries. Results The review of existing prevention strategies highlights various approaches, including public awareness campaigns, enhanced product regulations, and the implementation of stricter safety standards for batteries and devices. Analysis of Susy Safe data helps characterize the issue, underscoring the frequency and circumstances of battery ingestions and provides an empirical basis to assess the effectiveness of existing prevention strategies and to guide the development of new policies. The combination of technological improvements and legislative initiatives could represent a significant breakthrough in preventing these dangerous injuries. Conclusions While technological innovations are promising, effective prevention of battery ingestion will require a multifaceted approach that integrates technology, education, public policy, and regulatory oversight. Collaboration among manufacturers, lawmakers, health professionals, and the community is essential to reduce the incidence of these medical emergencies. Key messages • Accidental ingestion of button batteries can cause severe and sometimes fatal injuries. • The combination of technological improvements and legislative initiatives could represent a significant breakthrough in preventing button batteries in children.

Histopathological Analysis of Esophageal Damage Caused by Coin-Shaped Lithium Batteries in Living Piglets.

More than 3,000 cases of accidental ingestion of coin-shaped lithium batteries (CSLBs) have been reported in the United States. Battery ingestion can cause serious injury and even death. Prior reports have indicated that complications often occur two or more hours after ingestion. However, to date, the temporal changes in esophageal damage remain unclear. To address this knowledge gap, we examined the histological features associated with these temporal changes. Six piglets were used as models. After laparotomy and thoracotomy, three CSLBs were inserted into the esophagus of each pig. The esophagi were removed for histological examination at 0.5, 1, 2, 4, 6, and 8 hours. The consumed capacities of the batteries were measured after removal. Mucosal damage began at the margins of batteries, gradually spreading to the centers of the negative pole. At 0.5 hours after implantation, although necrosis at the limbus had reached the muscle layer, it became more extensive with time. At six hours, the full-thickness wall was damaged in all areas of the negative pole. The consumed capacity increased markedly after six hours, at which point holes opened in the outer case on the positive pole of the battery with observed electrolyte leakage. The consumed capacity was correlated with the amount of alkaline hydroxide ions. Our study revealed changes over time in injury site and depth. Although early diagnosis and treatment are necessary, managing batteries to avoid complications is also important. Additionally, developing safer batteries is warranted.

Surgical management protocol for disk battery ingestion.

Disk battery (DB) ingestion in children can lead to severe complications and mortality. This study details our experience in managing DB ingestion and its complications. We analyzed data from all patients treated for DB ingestion at our hospital from June 2010 to January 2024. A protocol established in 2010 requires angio-CT scans for esophageal DB cases and a multidisciplinary approach involving gastroenterologists, otolaryngologists, pediatric and airway surgeons, and cardiac surgeons. We treated 22 patients. In June 2010, following the tragic death of a patient from an undiagnosed DB ingestion that led to an aortoesophageal fistula, our protocol was established. All DBs were removed endoscopically. Four patients needed additional surgery: two had tracheal resection/anastomosis and esophageal repair for large tracheoesophageal fistulas; one required aortic wall reinforcement with a patch; one underwent endoscopic removal with a sternal split to explore the aortic arch. All 22 patients survived and recovered clinically. One developed bilateral vocal cord palsy as a complication. Effective management of DB ingestion complications necessitates a collaborative, multidisciplinary approach. Our protocol has improved management strategies and patient outcomes.

Complications of button battery ingestion or insertion in children: a systematic review and pooled analysis of individual patient-level data.

Button battery (BB) exposures are common in children and can have devastating consequences. We reviewed current evidence on the complications associated with BB exposure and identified predictors of outcomes using individual patient-level data. We carried out a systematic review and pooled analysis by searching MEDLINE, Embase, and Scopus up to May 19, 2023. Included studies describe complications following BB exposures in children (aged < 18years). Odds ratios (ORs) were calculated using binary logistic regression to measure associations between predictive factors and different outcomes. Two-hundred seventeen studies (439 children) were included. The median age at presentation was 1.75 [interquartile range (IQR) 1.00-3.00] years and 399 (90.9%) exposures were ingestions. Of the 380 cases reporting sex, 162 (42.6%) were female. Feeding (192, 48.1%) and respiratory difficulties (138, 34.6%) were common presenting features for ingestions, while symptomatology was site-specific for insertions. Common complications included oesophageal mucosal damage alone (105, 26.3%) and tracheooesophageal fistula (93, 23.3%) for ingestions, and nasal septal perforation (22, 55.0%) and mucosal damage alone (13, 32.5%) for insertions. Intestinal perforation occurred in 2.5% of ingestion cases, including perforation of Meckel's diverticulum, peritonitis, and jejunocolic fistula. Vascular complications were common among children who died. Age (≤ 2years), battery exposure duration (> 6hours), and battery diameter (≥ 20mm) were associated with common and severe complications of ingestions. BB injuries are time-critical, with severe sequelae predominantly affecting young children. Diagnosis is challenging. Preventative work through regulation and safer battery design are required to eliminate this problem.

Clinical features, management, and complications of paediatric button battery ingestions in Canada: an active surveillance study using surveys of Canadian paediatricians and paediatric subspecialists

Clinical features, management, and complications of paediatric button battery ingestions in Canada: an active surveillance study using surveys of Canadian paediatricians and paediatric subspecialists

Consumer Trends Reflected in the Contents of the Pediatric Esophagus: A 20-Year Review.

To evaluate epidemiological trends of pediatric esophageal foreign body (EFB) ingestion over two decades. A retrospective analysis was performed using data from the National Electronic Injury Surveillance System (NEISS) database for children <18 years who presented to a United States Emergency Department (ED) with EFB between 2003 and 2022. Number of cases and type of EFB were recorded. Rates of EFBs over time were analyzed via linear regression. A total of 52,315 EFB cases were identified over the 20-year period, with a national estimate of 1,589,325 cases. The most frequently ingested objects were coins (37.6%), toys (13.5%), and batteries (6.8%). Overall incidence of EFB ingestion increased from 7.3 to 14.2/10,000 children from 2003 to 2022 (R2 = 0.8, p < 0.0001). Incidence of coin ingestion increased from 3 to 4.5/10,000 children (R2 = 0.06, p = 0.335) but represented a smaller proportion of all EFB over time (66% in 2003 versus 43% in 2022). Incidence of magnet, battery, and toy ingestion have increased from 0.3 to 1.0/10,000 (R2 = 0.9, p < 0.0001), 0.3 to 1/10,000 (R2 = 0.7, p < 0.0001), and 0.6 to 2.3/10,000 (R2 = 0.8, p < 0.0001) children, respectively, between 2003 and 2022. The proportion of magnet, battery, and toy ingestion have increased over time (3.2%, 6.5%, and 11.8%, respectively, in 2003 to 11.4%, 11.7%, and 22.2%, respectively, in 2022). Magnet, battery, and toy ingestion have increased significantly in the past two decades, while the proportion of coin ingestion has decreased. This trend may reflect shifts within the consumer market and increased availability of electronics concurrent with the adoption of digital currency. 4 Laryngoscope, 2024.

European paediatricians need to be more aware of the risks faced by children who swallow button batteries and how to treat them.

The aim of this study was to assess how aware European paediatricians were of the risks faced by children who swallowed button batteries and the advice for managing such cases. An Internet-based survey was conducted among European paediatricians between 1 April 2023 and 31 May 2023. The researchers contacted members of the European Academy of Paediatrics Research in Ambulatory Setting Network and a number of European national paediatric societies. Responses were received from 605 paediatricians (66.0% females) in 41 countries and 64.5% had encountered cases of button battery ingestion. Only 31.2% had received specific training and only 35.7% were familiar with the advice issued by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Academy of Pediatrics. While 90.8% of respondents correctly recognised the need for hospitalisation of a child after button battery ingestion, only 30.1% of them identified all symptoms and 58.2% could accurately determine the appropriate diagnostic scope. One in ten underestimated the health or life risks. These deficiencies were significantly attributed to a lack of adequate training (p < 0.01). The overwhelming majority of the respondents expressed the need to increase awareness among physicians and childcare providers, mainly through social media campaigns and advertisements. European paediatricians were insufficiently aware of button battery ingestion risks and management, with significant gaps in training and familiarity with advice. Respective education for medical practitioners and raising public awareness should be markedly strengthened.

The role of endoscopy in gastric button battery ingestions: A case and literature review.

The role of endoscopy in gastric button battery ingestions: A case and literature review.

Button Battery Ingestion in Children - A Tertiary Center Experience in Endoscopic Management and a Brief Review of the Literature

Button Battery Ingestion in Children - A Tertiary Center Experience in Endoscopic Management and a Brief Review of the Literature

Death following cylindrical battery ingestion associated with toxic manganese levels.

Cases of battery ingestion are well documented in the scientific literature, especially concerning button cell battery ingestion in children. In this instance, the authors present an atypical case of a young man who voluntarily ingested a cylindrical alkaline battery containing manganese. The patient died approximately a week later, despite not exhibiting any specific symptoms. The battery was found in the cecum during the autopsy, showing deterioration at its positive pole. The cecal mucosa exhibited two ulcerations without perforation. Histological analysis revealed intestinal ischemia in the cecum, with no microscopic lesions in other organs. Toxicology reports indicated high levels of manganese in both cardiac and peripheral blood. Considering all the results from the additional analyses, the experts concluded that the death was likely of multifactorial origin, associated with a toxic blood concentration of manganese. To the best of our knowledge, this is the first recorded death following the ingestion of a cylindrical battery, and the first instance of manganese intoxication resulting from the ingestion of an alkaline battery. The authors will present the case and provide a literature review to assess the extent to which the presence of manganese may have contributed to the fatality.

Management of Button Battery Ingestion

Management of Button Battery Ingestion

'You can be as vigilant as you can, yet they make their way in': A descriptive study of parent and caregiver perspectives towards keeping children safe from button batteries.

Button batteries pose a significant threat to young children, and parents and caregivers play an important role in keeping children safe from button batteries, especially in the home environment. However, little is known regarding parent or caregiver perspectives on button battery safety, in particular, the threat they pose to children. The aim of this study was to examine perspectives on button battery safety to enable tailored prevention strategies and to examine parent and caregiver perspectives on button battery safety in the home. One hundred and seventy-four parents and caregivers of children aged 0-5 completed a cross-sectional online survey. Distribution occurred via social media. The survey contained multiple-choice questions pertaining to button battery knowledge and attitudes. Most respondents recognised the dangers of button battery ingestion, yet only 37% knew of button battery ingestion symptoms. While 68% knew of household items containing button batteries, 21% were aware of product-recall information sources. Approximately 64% understood immediate post-ingestion steps, but only 31% were familiar with first-aid procedures. From an attitudinal standpoint, 95% understood the importance of child supervision around button batteries, 78% prioritised battery safety in toy purchases, and 17% found current safety labels unsatisfactory. This study provides a foundation for ongoing investigation of parent and caregiver perspectives on button battery home safety. Ongoing, comprehensive education and public-safety campaigns are needed to rectify gaps in knowledge regarding button battery safety, and to reduce the risk of button battery ingestion in children.

Button Battery Ingestion in Children: An Educational Review for Perioperative Nursing

Button battery ingestion is potentially fatal, especially in children less than 6 years of age, most commonly due to esophageal perforation. The number of ingestions and complications has risen significantly in recent decades. Impacted button batteries should ideally be removed urgently within 2 hours of ingestion. However, many ingestions go unwitnessed, and children may present with variable, vague symptoms. The recommendation now is that children over the age 12 months consume honey when a button battery ingestion is witnessed or diagnosed, if less than 12 hours have elapsed. Importantly, though, honey should not be consumed if perforation is suspected. Induction of general anesthesia and battery removal should not be delayed to satisfy NPO guidelines, even if the child has eaten.

Trachea-o-esophageal Fistula following Button Battery Ingestion, Presenting One Month after the Event- A Rare Presentation

Trachea-o-oesophageal fistula (TEF) formation after battery ingestion is a fatal complication with severe consequences. Urgent removal of battery is necessary within few hours. Persistent oral intolerance, respiratory difficulty or clinical deterioration after removal of battery should raise a suspicion of oesophageal rupture/leak or TEF. We present case of a 3-year-old who ingested button battery, which was diagnosed immediately but due to delay in referral to the concerned specialty the battery was removed on the 2nd day followed by large oesophageal rupture. However initially the child improved after the repair, the development of TEF was presented much later which was a rare presentation. A large fistula which was not closed by conservative approach was successfully closed surgically. The child was recovered after the repair, and the confirmation of adequate repair by esophagoscopy was done. Button battery ingestion (BBI) should be considered a surgical emergency, requiring urgent removal and vigilant monitoring.

Imaging approach to ingested foreign bodies in the neck.

Foreign body ingestion is a common clinical occurrenceworldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.

Chronic stridor in a toddler after ingestion of a discharged button battery: a case report

BackgroundButton battery (BB) ingestions (BBI) are increasingly prevalent in children and constitute a significant, potentially life-threatening health hazard, and thus a pediatric emergency. Ingested BBs are usually charged and can cause severe symptom within 2 h. Discharged BBs ingestion is very rare and protracted symptom trajectories complicate diagnosis. Timely imaging is all the more important. Discharged BBs pose specific hazards, such as impaction, and necessitate additional interventions.Case presentationWe present the case of a previously healthy 19-month-old girl who was admitted to our pediatric university clinic in Germany for assessment of a three-month history of intermittent, mainly inspiratory stridor, snoring and feeding problems (swallowing, crying at the sight of food). The child’s physical examination and vital signs were normal. Common infectious causes, such as bronchitis, were ruled out by normal lab results including normal infection parameters, negative serology for common respiratory viruses, and normal blood gas analysis, the absence of fever or pathological auscultation findings. The patient’s history contained no evidence of an ingestion or aspiration event, no other red flags (e.g., traveling, contact to TBC). Considering this and with bronchoscopy being the gold standard for foreign body (FB) detection, an x-ray was initially deferred. A diagnostic bronchoscopy, performed to check for airway pathologies, revealed normal mucosal and anatomic findings, but a non-pulsatile bulge in the trachea. Subsequent esophagoscopy showed an undefined FB, lodged in the upper third of the otherwise intact esophagus. The FB was identified as a BB by a chest X-ray. Retrieval of the battery proved extremely difficult due to its wedged position and prolonged ingestion and required a two-stage procedure with consultation of Ear Nose Throat colleagues. Recurring stenosis and regurgitation required one-time esophageal bougienage during follow-up examinations. Since then, the child has been asymptomatic in the biannual endoscopic controls and is thriving satisfactorily.ConclusionThis case describes the rare and unusual case of a long-term ingested, discharged BB. It underscores the need for heightened vigilance among healthcare providers regarding the potential hazards posed by discharged BBIs in otherwise healthy children with newly, unexplained stridor and feeding problems. This case emphasizes the critical role of early diagnostic imaging and interdisciplinary interventions in ensuring timely management and preventing long-term complications associated even to discharged BBs.

Public knowledge of button battery ingestions: A social media based cross-sectional analysis

IntroductionButton battery (BB) ingestion injuries are a devastating and preventable event within the pediatric population. Efforts to reduce the prevalence of esophageal button battery ingestion injuries include primary preventative measures. It is integral to assess the public's baseline knowledge about BB injuries to tailor future primary prevention efforts. MethodsThis is a crowdsourcing survey-based study. Participants were notified through our institution's Twitter and Instagram accounts. ResultsThere were 930 completed survey responses from May to June 2022. The survey found that 87% (791/910) knew that swallowing a BB could cause injury and 71% knew that it could cause death (642/905). Eight-five percent of respondents did not know what signs and symptoms to look for after BB ingestion, only 30% (99/340) of healthcare professionals felt they would know. Only 10.1% (94/930) of participants knew to give children over 12 months old honey after suspected BB ingestion. Thirty-four percent (311/930) knew that complications could still occur even after BB were removed. Seventy-seven percent (719/930) knew that a dead BB could cause injury but only 17% knew the correct way to dispose of a dead button battery (158/930). Only 8% (72/930) of participants were knew that wrapping dead BB in tape could potentially prevent injury. ConclusionThe current study reveals gaps in the public's understanding of BB injury including: the presentation of BB injuries; the delayed harm of BB impactions; management and mitigation strategies, and BB disposal methods. This survey provided imperative insights to help guide future education and primary prevention initiatives. Level of evidence3.

Animal study: Basic mechanism of vocal cord paralysis caused by button battery ingestion in children

PurposeVocal cord paralysis has been reported as a common complication of button battery (BB) ingestion, and there is a need to confirm the mechanism of vocal cord paralysis for the development of a standardized treatment. MethodsA new CR2032 BB and artificial saliva were placed in a fresh pig esophagus with the recurrent laryngeal nerve (RLN); the negative electrode faced the nerve in the experimental group, while the positive electrode faced the nerve in the control group. The pH values of the intra- and extraesophageal walls were measured simultaneously. Pathological examination was performed after the esophagus and nerves were damaged. ResultsAfter BB ingestion, the pH near the intraesophageal negative electrode increased rapidly, reaching 11.5 at 30 min and over 14 at 6 h, while the extraesophageal pH did not change at 1 h and began to accelerate after 2 h, reaching 10 at 6 h. After 6 h of exposure, the pathological section showed that the structure of the mucosa, submucosa, and muscle layer were destroyed; chromatin in the nucleus faded, and part of the nerve bundle in the adventitia had liquefaction necrosis. ConclusionThe basic mechanism of vocal cord paralysis caused by BB ingestion is that the OH− generated by the electrolytic reaction of the negative electrode penetrates the esophageal wall and corrodes the RLN, which may be the cause of vocal cord paralysis caused by BB ingestion without esophageal perforation.

Delayed Presentation of Button Battery Ingestion in a 6-year-old Girl – A Case Report

Foreign body ingestion is a common presentation to Otorhinolaryngology Department (ORL) especially among pediatrics population. Foreign body can be food or non-food related substances. Button battery ingestion is a life-threatening emergency which can cause injuries such as oesophageal strictures, perforations, tracheoesophageal fistulas, mediastinitis and aortoesophageal fistulas. The extent of damage increases with the duration the button battery remains lodged, underscoring the importance of promptly identifying ingestion. We present a case of a child with a delayed presentation of battery ingestion and a complication of esophageal injury.