Button Battery Ingestion-Case Series from Lakonia, Greece

Objectives and Study: Button battery ingestions epitomize the challenge among pediatric foreign body ingestions as the outcome can vary from harmless to lethal. The serious outcomes refer to children younger than 5years old and when ingested batteries are larger than 20mm-diameter(higher-risk patients).

Esophagus is the target tissue of caustic injury and acute endoscopic treatment is needed. In cases, where battery lies beyond the esophagus (stomach, bowel etc) and the patient is asymptomatic, abdominal radiographs and observation are advocated. Endoscopic removal is suggested only if the battery remains inside the stomach 4 days after ingestion.

Methods: We report two cases of toddlers, presented in our pediatric department, that ingested button batteries with their diagnostic X-rays.

The first was a 3-year-old girl that ingested a battery smaller than 12mm-diameter (10mm) 2^1/2 hours prior to her admission. Her vital signs were stable (HR:108-114/min) and was asymptomatic. An X-ray was obtained that revealed a radiopaque object(battery) in the bowel. From the laboratory exams, only increased amylase levels were found(221U/l, with normal values:30-118U/l).

The second was a 2.5-year-old girl that ingested a battery larger than 12mm-diameter ( >20mm) 1 hour prior to her admission. Her vital signs where stable (HR:100/min) and also remained asymptomatic. The X-ray that was performed revealed a battery in the stomach. No laboratory exams were obtained.

Results: Both children received intravenous(iv) fluids and ranitidine as prophylaxis and were immediately transferred to a pediatric hospital with endoscopic unit. They remained asymptomatic throughout their stay and endoscopic intervention was not needed. The battery was dismissed through the stool in both cases, during the second( 2^nd) and third( 3^rd) day after ingestion, respectively.

Conclusion: Button battery ingestions, where battery lies beyond the esophagus and the patient remains asymptomatic, should be managed with caution, as esophageal damage cannot be excluded. Endoscopic intervention should be within immediate reach whether or not it is actually performed in the end.