Advertisement

Pediatric Radiology

, Volume 47, Issue 2, pp 178–185 | Cite as

Imaging button battery ingestions and insertions in children: a 15-year single-center review

  • Brian S. Pugmire
  • Tom K. Lin
  • Scott Pentiuk
  • Alessandro de Alarcon
  • Catherine K. Hart
  • Andrew T. TroutEmail author
Original Article

Abstract

Background

Recent studies have shown an increase in morbidity associated with button battery ingestions in children.

Objective

To perform a comprehensive, imaging-focused review of all patients with confirmed button battery ingestions/insertions imaged at our institution in the last 15 years.

Materials and methods

Radiology reports from Jan. 1, 2000, to July 12, 2015, were searched for the terms “battery” and “batteries.” Confirmed cases of battery ingestion/insertion for which images were available were reviewed. Cases were reviewed for imaging studies performed, imaging findings, patient demographics, clinical history and management. Two pediatric gastroenterologists reviewed endoscopic images and graded mucosal injuries in selected cases.

Results

Two hundred seventy-six cases were reviewed. All patients were imaged with radiography, 19 with fluoroscopy (6.8%), and 4 with CT (1.4%). Batteries retained in the esophagus (n = 27, 9.8%) were larger in diameter on average than those that had passed distally (22.1 ± 3.3 mm vs. 13.7 ± 1.6 mm, P<0.0001). Battery diameter ≥20 mm was associated with esophageal impaction (P<0.0001) and higher grade esophageal injury (P<0.0001). Mean battery diameter was greater for patients with grade 1 or higher mucosal injury than for patients with no mucosal injury (22.1 ± 2.1 mm vs. 14.7 ± 4.5 mm, P<0.0001). Sixteen percent (4/25) of patients with grade ≥1 esophageal injury had batteries in the stomach on initial imaging. Five patients (1.8%) had serious clinical complications (e.g., esophageal perforation, tracheoesophageal fistula).

Conclusion

Button batteries >20mm in diameter warrant increased clinical scrutiny due to higher likelihood and severity of injury. Implementation of recent pediatric gastroenterology societal guidelines will likely lead to a substantial increase in the number of CT and MRI examinations.

Keywords

Button batteries Children Computed tomography Esophagus Foreign body Gastrointestinal tract Radiography 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Votteler TP, Nash JC, Rutledge JC (1983) The hazard of ingested alkaline disk batteries in children. JAMA 249:2504–2506CrossRefPubMedGoogle Scholar
  2. 2.
    Litovitz T (1983) Button battery ingestions. A review of 56 cases. JAMA 249:2495CrossRefPubMedGoogle Scholar
  3. 3.
    Litovitz TL (1985) Battery ingestions: product accessibility and clinical course. Pediatrics 75:469–476PubMedGoogle Scholar
  4. 4.
    Litovitz T, Schmitz BF (1992) Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics 89:747–757PubMedGoogle Scholar
  5. 5.
    Thompson N, Lowe-Ponsford F, Mant TG et al (1990) Button battery ingestion: a review. Adverse Drug React Acute Poisoning Rev 9:157–180PubMedGoogle Scholar
  6. 6.
    Litovitz T, Whitaker N, Clark L (2010) Preventing battery ingestions: an analysis of 8648 cases. Pediatrics 125:1178–1183CrossRefPubMedGoogle Scholar
  7. 7.
    Litovitz T, Whitaker N, Clark L et al (2010) Emerging battery-ingestion hazard: clinical implications. Pediatrics 125:1168–1177CrossRefPubMedGoogle Scholar
  8. 8.
    Sharpe SJ, Rochette LM, Smith GA (2012) Pediatric battery-related emergency department visits in the United States, 1990–2009. Pediatrics 129:1111–1117CrossRefPubMedGoogle Scholar
  9. 9.
    Jatana KR, Litovitz T, Reilly JS et al (2013) Pediatric button battery injuries: 2013 task force update. Int J Pediatr Otorhinolaryngol 77:1392–1399CrossRefPubMedGoogle Scholar
  10. 10.
    Brumbaugh DE, Colson SB, Sandoval JA et al (2011) Management of button battery induced hemorrhage in children. J Pediatr Gastroenterol Nutr 52:585–589CrossRefPubMedGoogle Scholar
  11. 11.
    Hamilton JM, Schraff SA, Notrica DM (2009) Severe injuries from coin cell battery ingestions: 2 case reports. J Pediatr Surg 44:644–647CrossRefPubMedGoogle Scholar
  12. 12.
    Centers for Disease Control and Prevention (CDC) (2012) Injuries from batteries among children aged <13 years--United States, 1995–2010. MMWR Morb Mortal Wkly Rep 61:661–666Google Scholar
  13. 13.
    Kramer RE, Lerner DG, Lin T et al (2015) Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 60:562–574CrossRefPubMedGoogle Scholar
  14. 14.
    Zargar SA, Kochhar R, Mehta S et al (1991) The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 37:165–169CrossRefPubMedGoogle Scholar
  15. 15.
    Leinwand K, Brumbaugh DE, Kramer RE (2016) Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions. Gastrointest Endosc Clin N Am 26:99–118CrossRefPubMedGoogle Scholar
  16. 16.
    Cetinkaya EA, Arslan İB, Cukurova İ (2015) Nasal foreign bodies in children: types, locations, complications and removal. Int J Pediatr Otorhinolaryngol 79:1881–1885CrossRefPubMedGoogle Scholar
  17. 17.
    Guidera AK, Stegehuis HR (2010) Button batteries: the worst case scenario in nasal foreign bodies. N Z Med J 123:68–73PubMedGoogle Scholar
  18. 18.
    Bakshi SS, Coumare VN, Priya M et al (2016) Long-term complications of button batteries in the nose. J Emerg Med 50:485–487CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Brian S. Pugmire
    • 1
  • Tom K. Lin
    • 2
  • Scott Pentiuk
    • 2
  • Alessandro de Alarcon
    • 3
    • 4
  • Catherine K. Hart
    • 3
    • 4
  • Andrew T. Trout
    • 1
    Email author
  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Division of Gastroenterology Hepatology and NutritionCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of Pediatric OtolaryngologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.Department of Otolaryngology––Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiUSA

Personalised recommendations