eMedicine Specialties > Emergency Medicine > Gastrointestinal

Disk Battery Ingestion: Differential Diagnoses & Workup

Author: Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Associate Professor, Department of Emergency Medicine, University of Texas-Houston
Contributor Information and Disclosures

Updated: Oct 2, 2009

Differential Diagnoses

Esophageal Perforation, Rupture and Tears
Esophagitis
Toxicity, Heavy Metals

Other Problems to Be Considered

Caustic ingestions

Workup

Laboratory Studies

  • Obtain blood and urine mercury levels only if the mercury-containing cell has been observed to fragment in the GI tract or radiopaque droplets are observed in the gut on radiographs.

Imaging Studies

  • Radiography 
    • Radiography is indicated to confirm the ingestion and to establish the location of ingested disk batteries.
    • Disk batteries have a relatively characteristic appearance on radiograph. When viewed from above, they appear much like a coin; however, a double density is often present. When viewed on edge, a much more rounded edge with a step off at the junction of the cathode and anode is seen (see Media file 3).
Lateral radiographic appearance of a 7.9-mm disk ...

Lateral radiographic appearance of a 7.9-mm disk battery. Photographed by Daniel J. Dire, MD.

Lateral radiographic appearance of a 7.9-mm disk ...

Lateral radiographic appearance of a 7.9-mm disk battery. Photographed by Daniel J. Dire, MD.

  • Batteries located in the esophagus on initial radiograph frequently (28%) pass into the stomach spontaneously.
  • Radiopaque droplets in the gut may be found on radiograph in patients with fragmented mercuric oxide cells.

More on Disk Battery Ingestion

Overview: Disk Battery Ingestion
Differential Diagnoses & Workup: Disk Battery Ingestion
Treatment & Medication: Disk Battery Ingestion
Follow-up: Disk Battery Ingestion
Multimedia: Disk Battery Ingestion
References

References

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  2. Litovitz T, Schmitz BF. Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics. Apr 1992;89(4 Pt 2):747-57. [Medline].

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  4. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). Dec 2007;45(8):815-917. [Medline].

  5. Chan YL, Chang SS, Kao KL, Liao HC, Liaw SJ, Chiu TF, et al. Button battery ingestion: an analysis of 25 cases. Chang Gung Med J. Mar 2002;25(3):169-74. [Medline].

  6. Slamon NB, Hertzog JH, Penfil SH, Raphaely RC, Pizarro C, Derby CD. An unusual case of button battery-induced traumatic tracheoesophageal fistula. Pediatr Emerg Care. May 2008;24(5):313-6. [Medline].

  7. Bass DH, Millar AJ. Mercury absorption following button battery ingestion. J Pediatr Surg. Dec 1992;27(12):1541-2. [Medline].

  8. Campbell JB, Foley LC. A safe alternative to endoscopic removal of blunt esophageal foreign bodies. Arch Otolaryngol. May 1983;109(5):323-5. [Medline].

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  10. Gordon AC, Gough MH. Oesophageal perforation after button battery ingestion. Ann R Coll Surg Engl. Sep 1993;75(5):362-4. [Medline].

  11. Lai MW, Klein-Schwartz W, Rodgers GC, Abrams JY, Haber DA, Bronstein AC. 2005 Annual Report of the American Association of Poison Control Centers' national poisoning and exposure database. Clin Toxicol (Phila). 2006;44(6-7):803-932. [Medline].

  12. Mariani PJ, Wagner DK. Foley catheter extraction of blunt esophageal foreign bodies. J Emerg Med. 1986;4(4):301-6. [Medline].

  13. Palmer O, Natarajan B, Johnstone A, Sheikh S. Button battery in the nose--an unusual foreign body. J Laryngol Otol. Oct 1994;108(10):871-2. [Medline].

  14. Sheikh A. Button battery ingestions in children. Pediatr Emerg Care. Aug 1993;9(4):224-9. [Medline].

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  16. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].

Further Reading

Keywords

battery ingestiondisk battery, watch battery, calculator battery, hearing aid battery, esophageal perforation, aortic perforation with exsanguinations, tracheoesophageal fistulae, esophageal damage, endoscopic retrieval, National Button Battery Ingestion Hotline, swallowed disk battery, button battery

Contributor Information and Disclosures

Author

Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Associate Professor, Department of Emergency Medicine, University of Texas-Houston
Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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