Severe tissue damage can result from BBI from as little as 2 h in situ. The most important mechanism is that of electrolysis of fluid in local oesophageal tissue which generates a current, and subsequently hydroxide, at the negative pole of the battery. The type of button battery is also important: the ubiquitous lithium button batteries have a higher voltage and capacitance than other types resulting in an increased production of hydroxide and therefore more tissue damage. Other mechanisms include pressure necrosis and leakage of alkaline electrolytes from the battery itself (however, this is supposedly less of a problem with lithium batteries which is said to cause less mucosal irritation). Delayed complications include but are not limited to: oesophageal perforation; oesophageal stricture; tracheo-oesphageal fistula; exsanguination after fistulation into a major blood vessel (e.g. aorto-oesophageal fistula); and vocal cord paralysis.
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