Battery Ingestion in Children: A Pediatric Tertiary Care Centre Experience

Background: Battery ingestion is a frequent problem in pediatric population and can lead to potentially serious complications, especially when located in the esophagus.

Objective: Describe battery ingestion cases requiring endoscopic removal and their complications.

Methods: Retrospective descriptive study of admissions for battery ingestion requiring endoscopic removal in a pediatric emergency department of a tertiary hospital (January 2009/December 2018).

Results: 29 cases, with an increasing number in the last four years (2018: 9 cases). Median age 26 months (8 months-9 years), 52% male. Witnessed ingestion in 24 (83%) patients; 16 (41%) patients were symptomatic, vomiting (21%) was the most frequent symptom. On the X-ray, 8/29 patients (28%) had an esophageal battery (EB) and 21/29 (72%) had a gastric battery (GB). The upper endoscopy revealed the battery (100% button lithium batteries) located in the esophagus (8), stomach (15), duodenum (1) or was not detected (5); median time until removal of EB was 21 hours (6h-21 days). All patients with EB presented with lesions of different severity: erosion (8), ulceration (6), necrosis (5) and perforation (2); 3 patients presented more than one lesion. Of all the cases of GB only a minor erosion was described. There were no cases of mortality reported.

Patients with EB had a more complicated clinical evolution, with prolonged hospital stay than GB [median 26 days (6days-80days) vs 14 hours (8hours-6days)] and prolonged follow-up [median 3 months (1month-8year)] vs 1.25 month (1month-1.5month)]; 2/8 (25%) had severe stricture after ingestion and are currently in endoscopic dilation program; one of them is being fed by gastrostomy.

Discussion: There has been an increasing number of battery ingestion in recent years. Esophageal batteries remain responsible for persistent severe lesions, mostly in patients with late removal. This study emphasizes the importance of primary prevention.