Button battery ingestion
http://www.100md.com
《美国医学杂志》
Asian Institute of Gastroenterology, Hyderabad, India
Abstract
Button batteries represent a special category of pediatric ingested foreign body because of the possibility of serious complications particularly if impacted in the esophagus. We report a case of a 3-year-old girl with severe mid esophageal burns due to a lodged battery. More awareness is required amongst physicians to avert such dangers and ensure prompt removal.
Keywords: Button battery; Corrosive; Esophagitis
The ingestion of foreign bodies is a common problem in the pediatric age group but fortunately the majority of ingested foreign bodies pass through the GI tract without any adverse effects.[1] Button batteries however represent a distinct type of foreign body because of the possibility of potentially catastrophic problems if not removed, early.[2] Nowadays with increasing accessibility of electronic toys and devices to children, ingestion of these miniature-sized batteries is on the rise.[3] The authors present the case of a 3-year-old girl who ingested a button battery and a nick of time removal averted a potentially disastrous complication.
Case report
A 3-year-old healthy girl presented to the outpatient department of our unit with a history of accidental ingestion of a button battery (CR2032, 3V), the size of a 50paise coin 48 hours ago. She complained of minor chest discomfort and difficulty in swallowing for the last 24hr. She was apparently symptom free for the first 24 hours post ingestion. An X-ray of the chest showed the coin shaped battery in the mid thorax. An immediate upper endoscopy revealed hemi circumferential denudation of the mucosa of the mid esophagus and the deformed leaking battery was seen adherent to the base Figure1. The leaking battery was retrieved endoscopically using a foreign body holding forceps uneventfully Figure2. A check endoscopy performed immediately showed deep ulceration and focal charring in the mid esophagus exposing the underlying muscularis propria Figure3. The distal esophagus, stomach and duodenum were normal. The child was kept nil by mouth and observed in the hospital over the next 48hours. She was subsequently allowed oral liquids and was put on oral sucralfate suspension at the time of discharge. At one week follow up, she had no further complaints and was able to take orally.
Discussion
The button battery is a single cell and is used to power the hearing aids, photographic equipment, digital watches, toys and a host of other electronic devices. These cells generally contain a heavy metal like mercury, silver, lithium and a strong hydroxide of sodium or potassium. Although they are sealed, occasional leakage of these corrosive substances is not uncommon and when they are stuck any where in the gastrointestinal tract, it can lead to mucosal damage by ulceration which may further lead on to perforation and secondary stricture formation.[4]
The problem of swallowed foreign bodies has long been recognized.[5] The peak age for such ingestion is between 6 months and 3 years, as it is the natural tendency for infants and children to put things in their mouth. Disc batteries represent a distinct type of pediatric foreign body because of their potential for severe morbidity and mortality. The frequency of ingested button batteries is estimated to be about 10 per million populations per year and 1 in every 1000 battery ingestions cause serious injuries. Most of the patients are expectedly children. The mechanism of injury has been elaborately studied.[6] These include electrolyte leakage from batteries causing burns, alkali produced from external currents, mercury toxicity and pressure necrosis. Perforation, fistulization and stricture formation are the common sequelae.[2] Esophageal lesions are particularly dangerous because of the proximity to major vessels and organs including heart. There have been reports of tracheo esophageal fistula[7] and Meckel's diverticulum perforation[8] secondary to disc battery ingestion.
Disc batteries are now becoming more widely available in India for a multitude of small electronic devices at home including a variety of toys. An increasing frequency of disc battery ingestion cases is therefore expected. A majority of these ingestions will be benign.[9] Physicians however need to be more aware of this potentially lethal outcome. Button battery ingestion cannot be managed in quite the same expectant way as most other foreign bodies swallowed. Any battery lodged in the esophagus must be urgently removed by endoscopy.[8] Other locations require close radiological and fluoroscopic follow up to confirm spontaneous elimination.[9] Surgical intervention may be required if the cell remains fixed to the stomach or gut mucosa for a prolonged period or there are sign of peritonitis. Manufacturers, physicians and parents share responsibility to prevent such accidents. The packaging of new cells should be made more secure with labelling to draw attention to the need to keep away from children. The cell compartment of electrical devices and toys should be less accessible to children. Additionally, the hazards of button battery ingestion should be publicized and prevention encouraged by parental education, manufacturers packing and safe disposal of used batteries.
To conclude, the authors presented a case of button battery ingestion, causing focal ulceration and charring in the mid esophagus, which could be removed endoscopically.
References
1. Votteler TP, Nash JC, Rutledge JC. The hazard of ingested alkaline disk batteries in children. JAMA 1983; 249(18): 2504-2506.
2. Samad L, Ali M, Ramzi H. Button battery ingestion: hazards of esophageal impaction. J Pediatr Surg 1999; 34(10): 1527-1531.
3. El Barghouty N. Management of disc battery ingestion in children. Brit J Surg 1991; 78: 247.
4. Shabino CL, Feinberg AN. Esophageal perforation secondary to alkaline b attery ingestion. JACEP 1979; 8(9): 360-363.
5. Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood: our experience and review of the literature. Eur J Emerg Med 1998; 5(3): 319-323.
6. Kost K M, Shapiro RS. Button battery ingestion: a case report and review of literature. J Otolaryngol 1987; 16(4): 252-257.
7. Vaishnav A, Spitz L. Alkaline battery induced tracheo-esophageal fistula: Case report. Brt J Surg 1989; 76: 1045.
8. Willis GA, Ho WL. Perforation of meckel diverticulum by alkaline hearing aid battery. Can Med Assoc J 1982; 126: 497- 498.
9. Kuhns DW, Dire DJ. Button battery ingestions. Ann Emerg Med 1989; 18(3): 293-300.(Banerjee R, Rao GV, Srira)
Abstract
Button batteries represent a special category of pediatric ingested foreign body because of the possibility of serious complications particularly if impacted in the esophagus. We report a case of a 3-year-old girl with severe mid esophageal burns due to a lodged battery. More awareness is required amongst physicians to avert such dangers and ensure prompt removal.
Keywords: Button battery; Corrosive; Esophagitis
The ingestion of foreign bodies is a common problem in the pediatric age group but fortunately the majority of ingested foreign bodies pass through the GI tract without any adverse effects.[1] Button batteries however represent a distinct type of foreign body because of the possibility of potentially catastrophic problems if not removed, early.[2] Nowadays with increasing accessibility of electronic toys and devices to children, ingestion of these miniature-sized batteries is on the rise.[3] The authors present the case of a 3-year-old girl who ingested a button battery and a nick of time removal averted a potentially disastrous complication.
Case report
A 3-year-old healthy girl presented to the outpatient department of our unit with a history of accidental ingestion of a button battery (CR2032, 3V), the size of a 50paise coin 48 hours ago. She complained of minor chest discomfort and difficulty in swallowing for the last 24hr. She was apparently symptom free for the first 24 hours post ingestion. An X-ray of the chest showed the coin shaped battery in the mid thorax. An immediate upper endoscopy revealed hemi circumferential denudation of the mucosa of the mid esophagus and the deformed leaking battery was seen adherent to the base Figure1. The leaking battery was retrieved endoscopically using a foreign body holding forceps uneventfully Figure2. A check endoscopy performed immediately showed deep ulceration and focal charring in the mid esophagus exposing the underlying muscularis propria Figure3. The distal esophagus, stomach and duodenum were normal. The child was kept nil by mouth and observed in the hospital over the next 48hours. She was subsequently allowed oral liquids and was put on oral sucralfate suspension at the time of discharge. At one week follow up, she had no further complaints and was able to take orally.
Discussion
The button battery is a single cell and is used to power the hearing aids, photographic equipment, digital watches, toys and a host of other electronic devices. These cells generally contain a heavy metal like mercury, silver, lithium and a strong hydroxide of sodium or potassium. Although they are sealed, occasional leakage of these corrosive substances is not uncommon and when they are stuck any where in the gastrointestinal tract, it can lead to mucosal damage by ulceration which may further lead on to perforation and secondary stricture formation.[4]
The problem of swallowed foreign bodies has long been recognized.[5] The peak age for such ingestion is between 6 months and 3 years, as it is the natural tendency for infants and children to put things in their mouth. Disc batteries represent a distinct type of pediatric foreign body because of their potential for severe morbidity and mortality. The frequency of ingested button batteries is estimated to be about 10 per million populations per year and 1 in every 1000 battery ingestions cause serious injuries. Most of the patients are expectedly children. The mechanism of injury has been elaborately studied.[6] These include electrolyte leakage from batteries causing burns, alkali produced from external currents, mercury toxicity and pressure necrosis. Perforation, fistulization and stricture formation are the common sequelae.[2] Esophageal lesions are particularly dangerous because of the proximity to major vessels and organs including heart. There have been reports of tracheo esophageal fistula[7] and Meckel's diverticulum perforation[8] secondary to disc battery ingestion.
Disc batteries are now becoming more widely available in India for a multitude of small electronic devices at home including a variety of toys. An increasing frequency of disc battery ingestion cases is therefore expected. A majority of these ingestions will be benign.[9] Physicians however need to be more aware of this potentially lethal outcome. Button battery ingestion cannot be managed in quite the same expectant way as most other foreign bodies swallowed. Any battery lodged in the esophagus must be urgently removed by endoscopy.[8] Other locations require close radiological and fluoroscopic follow up to confirm spontaneous elimination.[9] Surgical intervention may be required if the cell remains fixed to the stomach or gut mucosa for a prolonged period or there are sign of peritonitis. Manufacturers, physicians and parents share responsibility to prevent such accidents. The packaging of new cells should be made more secure with labelling to draw attention to the need to keep away from children. The cell compartment of electrical devices and toys should be less accessible to children. Additionally, the hazards of button battery ingestion should be publicized and prevention encouraged by parental education, manufacturers packing and safe disposal of used batteries.
To conclude, the authors presented a case of button battery ingestion, causing focal ulceration and charring in the mid esophagus, which could be removed endoscopically.
References
1. Votteler TP, Nash JC, Rutledge JC. The hazard of ingested alkaline disk batteries in children. JAMA 1983; 249(18): 2504-2506.
2. Samad L, Ali M, Ramzi H. Button battery ingestion: hazards of esophageal impaction. J Pediatr Surg 1999; 34(10): 1527-1531.
3. El Barghouty N. Management of disc battery ingestion in children. Brit J Surg 1991; 78: 247.
4. Shabino CL, Feinberg AN. Esophageal perforation secondary to alkaline b attery ingestion. JACEP 1979; 8(9): 360-363.
5. Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood: our experience and review of the literature. Eur J Emerg Med 1998; 5(3): 319-323.
6. Kost K M, Shapiro RS. Button battery ingestion: a case report and review of literature. J Otolaryngol 1987; 16(4): 252-257.
7. Vaishnav A, Spitz L. Alkaline battery induced tracheo-esophageal fistula: Case report. Brt J Surg 1989; 76: 1045.
8. Willis GA, Ho WL. Perforation of meckel diverticulum by alkaline hearing aid battery. Can Med Assoc J 1982; 126: 497- 498.
9. Kuhns DW, Dire DJ. Button battery ingestions. Ann Emerg Med 1989; 18(3): 293-300.(Banerjee R, Rao GV, Srira)