Pediatr Gastroenterol Hepatol Nutr.  2016 Mar;19(1):20-28. 10.5223/pghn.2016.19.1.20.

Foreign Body Ingestion in Children: Should Button Batteries in the Stomach Be Urgently Removed?

• Lee JH
• Lee JH
• Shim JO
• Lee JH
• Eun BL
• Yoo KH

• KMID: 2160472
• DOI: http://doi.org/10.5223/pghn.2016.19.1.20

Abstract

PURPOSE
Foreign body (FB) ingestion is common in children, and button battery (BB) ingestion has been increasing in recent years. This study was to identify factors related to outcomes of FB ingestion, particularly BBs in the stomach. We evaluated whether the current recommendations are appropriate and aimed to suggest indications for endoscopic removal of BB in the stomach in young children.
METHODS
We investigated patient age, shape, size, location of FBs, spontaneous passage time and resulting complications among 76 children. We observed types, size, location of BB and outcomes, and analyzed their associations with complications.
RESULTS
Coins and BB were the two most common FBs. Their shapes and sizes were not associated with the spontaneous passage time. Size, spontaneous passage time, and age were also not associated with any specific complications. For BB ingestion, all 5 cases with lithium batteries (≥1.5 cm, 3 V) presented moderate to major complications in the esophagus and stomach without any symptoms, even when the batteries were in the stomach and beyond the duodenum, while no complications were noted in 7 cases with alkaline batteries (<1.5 cm, 1.5 V) (p=0.001). All endoscopies were conducted within 24 hours after ingestion.
CONCLUSION
The type and voltage of the battery should be considered when determining whether endoscopy is required to remove a BB in the stomach. For lithium battery ingestion in young children, urgent endoscopic removal might be important in order to prevent complications, even if the child is asymptomatic and the battery is smaller than 2 cm.

Keyword

Foreign bodies; Endoscopy; Ingestion; Button battery

MeSH Terms

Child*
Duodenum
Eating*
Endoscopy
Esophagus
Foreign Bodies*
Humans
Lithium
Numismatics
Stomach*
Lithium

Figure

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  Fig. 1 Flow diagram of patient selection.

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  Fig. 2 Age distribution (mean age, 3.13±3.07 years) of the 76 patients (44 boys [57.3%] and 32 girls [42.7%]) with foreign body ingestion.

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  Fig. 3 Endoscopic fingings of children with lithiuim battery (2.0 cm, 3 V) lodged in the upper esophageal sphincter (UES). The lithium battery was removed from the UES within two hours after ingestion. (A) Mucosal burns and two linear ulcerations with dirty exudate and bleeding were noted in the UES. (B) After five days, a linear deep ulceration with basal whitish exudate and peripheral mucosal edema was remained. A shallow linear ulceration was noted in the opposite side of the esophagus.

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  Fig. 4 Endoscopic fingings of children with lithiuim battery (1.6 cm, 3 V) lodged in the stomach. The lithium battery was removed from the stomach within five hours. (A) Linear ulcerations with blood clots and diffuse mucosal edema were noted in the body. (B) Ulcerations with dirty exudates and diffuse mucosal edema were noted in the antrum. (C) After three days, there was sign of mucosal traction accompanying surrounding edema along the two linear ulceration bases in opposing directions in the antrum.

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