Button Battery Ingestion
Everything in the library about button battery ingestion — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
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QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video8:10 · Mar 2024
Evidence & Research
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Journal of pediatric surgery Article Review: April 2023, IPEG issue
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing three articles from the April 2023 issue, the IPEG issue with editor Dr. Mark Wulkan and authors Drs. Luzia Toselli,
podcast13:22 · Jul 2023
Case-Based Learning
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Button Battery Ingestion
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At the 7th Annual Pediatric Surgery Update Course, Dr. Daniel von Allmen discusses management after button battery ingestion.
video14:28 · Mar 2020
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison
A 1992 study reviewed more than 2000 cases of button battery ingestion in children and found no deaths.
host_summaryEm Gootee0:41 ↗
Recent studies have found a sevenfold increase in fatalities following button battery ingestions.
host_summaryEm Gootee0:52 ↗
The increase in fatalities is because of the change to a 20-volt lithium cell which causes coagulative necrosis.
host_summaryEm Gootee0:59 ↗
There are 3 locations in the esophagus where button batteries tend to get stuck: the upper esophageal sphincter, behind the aortic arch, and at the lower esophageal sphincter.
clinicalAaron Garrison1:06 ↗
When a button battery sits in one of these positions, it causes transmural injury and will make a fistula between the esophagus and adjacent structures including trachea, blood vessels, or vocal cords.
host_summaryEm Gootee1:14 ↗
High-risk criteria include younger patients with smaller esophagus.
clinicalAaron Garrison1:33 ↗
A larger battery over 20 millimeters or greater is riskier.
host_summaryEm Gootee1:39 ↗
Longer duration that the battery has been in the esophagus is associated with worse outcomes.
clinicalAaron Garrison1:43 ↗
A battery behind the aortic arch is more concerning.
host_summaryEm Gootee1:49 ↗
If a patient has had a battery removed and presents later with a bleed, that is an emergency that needs to be taken seriously and requires a plan.
clinicalAaron Garrison1:52 ↗
In a Colorado study of 13 patients with high severity button battery injuries, 30% had esophageal perforation.
host_summaryEm Gootee2:05 ↗
In the Colorado study, 23% of patients developed stricture.
host_summaryEm Gootee2:14 ↗
Some patients in the Colorado study required G-tube placement and stayed in the hospital for nearly 2 weeks.
host_summaryEm Gootee2:16 ↗
Almost 25% of patients in the Colorado series died.
epidemiologicalAaron Garrison2:22 ↗
Two of the fatalities in the Colorado series presented with the button batteries already in the stomach.
epidemiologicalAaron Garrison2:22 ↗
Sentinel bleeds can be the first sign of aortoenteric fistulas.
host_summaryEm Gootee2:32 ↗
Any small communication between the esophagus and the aorta can be potentially life-threatening.
clinicalAaron Garrison2:41 ↗
Some aortoesophageal fistulas showed up over 2 weeks after the batteries were removed.
host_summaryEm Gootee2:50 ↗
Aortoesophageal fistulas do not always happen in the hospital, so having a high index of suspicion and a plan for what to do once the battery is removed is helpful.
clinicalAaron Garrison2:55 ↗
For sick patients with esophageal foreign bodies and active bleeding or clinical instability, it is recommended to have GI surgery and CT surgery available for the procedure.
guidelineAaron Garrison3:26 ↗
Imaging beforehand with a CTA to assess inflammation and proximity to the aorta is helpful.
host_summaryEm Gootee3:39 ↗
If imaging shows injury close to the aorta, continue NPO and antibiotics and repeat MRI in 5 to 7 days to assess the trajectory of inflammation.
guidelineAaron Garrison3:47 ↗
If there is any bleeding or concern for sentinel bleed, have a plan with interventional radiology, cardiology, or anyone who can help in that situation.
host_summaryEm Gootee3:59 ↗
In one case report with a pseudoaneurysm from the arch of the aorta, repair was done with a staged approach: sternotomy on bypass to fix the aorta with a graft, followed by flap repair of the esophagus.
host_summaryEm Gootee4:10 ↗
For high-risk patients (less than 5 years old, larger battery size), endoscopic evaluation of the esophagus is recommended because the duration of battery presence higher up than the stomach is unknown.
guidelineAaron Garrison4:30 ↗
The need for ECMO or cardiopulmonary bypass depends on the location of the fistula and whether you can intubate past the injury enough to ventilate during the case.
clinicalAaron Garrison4:43 ↗
If the fistula is near the carina, complex airway reconstruction will be needed and adequate ventilation during the case will not be possible.
clinicalAaron Garrison4:59 ↗
In one case with a large tracheoesophageal fistula, the patient was placed on ECMO because they were unable to adequately ventilate.
clinicalAaron Garrison5:21 ↗
In the Cincinnati Children's case, an interposition graft was performed by removing a segment of trachea and using that trachea as the front wall of the esophagus.
clinicalAaron Garrison5:45 ↗
Button batteries are ingested more than 3500 times per year in the United States.
host_summaryEm Gootee6:10 ↗
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