eMedicine Specialties > Emergency Medicine > Gastrointestinal

Disk Battery Ingestion: Follow-up

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

Follow-up

Transfer

  • Transfer patients with disk batteries lodged in the esophagus to a medical treatment facility capable of performing endoscopic procedures.

Deterrence/Prevention

  • More than one half of ingested batteries (53%) were removed from a product before ingestion. Products need to be designed with secure battery compartments that can withstand a child's prying hands or a fall.

Complications

  • Esophageal stenosis may occur from batteries lodged in the esophagus, requiring repeated dilations or surgery.
  • Other reported complications from esophageal lodgment include esophageal perforation and tracheoesophageal fistula formation. One patient had esophageal perforation only 6 hours after ingestion.
  • The possibility of heavy metal poisoning, especially from mercury, has been considered. A typical battery may contain from 15-50% mercuric oxide, leading to possible ingestion of up to 5 g of mercury, a potentially lethal amount. This theoretical threat of toxicity has not been borne out by clinical experience. In a series of 2382 battery ingestions, no clinical evidence of mercury toxicity was observed.2
  • A spent cell, which no longer has power, may still maintain considerable residual voltage. This may account for the finding that the discharge state of the battery does not appear to be related to the patient's outcome.
  • Retrograde movement of the battery from the stomach to the esophagus has been reported as a complication of use of ipecac syrup, necessitating emergent endoscopic removal. If the battery produces a mucosal burn, a theoretical risk exists of battery aspiration and perforation of the esophagus or stomach.

Prognosis

  • The usual outcome of disk battery ingestions is an uneventful passage. No deaths attributed to disk battery ingestion were reported to the American Academy of Poison Control Centers from 1986-2003 (see Media file 2).
Exposures to disk batteries reported to the Ameri...

Exposures to disk batteries reported to the American Association of Poison Control Centers, 1986-2007.

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Exposures to disk batteries reported to the Ameri...

Exposures to disk batteries reported to the American Association of Poison Control Centers, 1986-2007.


Patient Education

Miscellaneous

Special Concerns

  • The National Button Battery Ingestion Hotline (202-625-3333) was established in 1982 at Georgetown University Hospital's National Capital Poison Center and functions as an emergency consultation service and case registry.
  • Disk batteries placed in the ear have been reported to cause the following:
    • Tympanic membrane perforation
    • Skin necrosis in the external auditory canal
    • Dysacusis from ossicle destruction
    • Facial nerve paralysis
    • Chondritis
  • Nasal septal perforation with resultant saddle deformity has been reported after disk battery placement in the nose. The clinical presentation of a nasal disk battery is usually unilateral nasal discharge with or without features of a secondary infection. Early recognition and removal of the battery is important to prevent adverse sequelae.
 


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
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References

  1. Kuhns DW, Dire DJ. Button battery ingestions. Ann Emerg Med. Mar 1989;18(3):293-300. [Medline].

  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].

  3. Langkau JF, Noesges RA. Esophageal burns from battery ingestion. Am J Emerg Med. May 1985;3(3):265. [Medline].

  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].

  9. Gomes CC, Sakano E, Lucchezi MC, Porto PR. Button battery as a foreign body in the nasal cavities. Special aspects. Rhinology. Jun 1994;32(2):98-100. [Medline].

  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].

  15. Tong MC, Van Hasselt CA, Woo JK. The hazards of button batteries in the nose. J Otolaryngol. Dec 1992;21(6):458-60. [Medline].

  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].

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Further Reading

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Keywords

battery ingestion, disk 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

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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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