A button battery lodged in the esophagus is a true emergency because of the extremely rapid action of the alkaline substance on the mucosa. Burns to the esophagus have been reported to occur in as little as 4 h, with perforation as soon as 6 h after ingestion. Button batteries in the esophagus require emergency removal if significant morbidity is to be averted. Outcome does not appear to be affected by battery discharge state but is affected by chemical composition. 12 Lithium cells are associated disproportionately with adverse outcome. Mercuric oxide cells tend to fragment more frequently than other cells; however, the threat of heavy metal poisoning has not been supported by the literature or clinical experience. This fact notwithstanding, blood and urine mercury levels should be measured whenever a mercury-containing cell is observed to have split while in the gastrointestinal tract.
Button ingestion can be managed along two main pathways (Fig, 7.2,-1). If the button battery is lodged in the esophagus, its location should be documented by radiograph; then emergent endoscopic removal is mandatory. Given the widespread expertise with endoscopy, we cannot recommend alternative techniques, many of which are associated with significant complications. Ipecac has no place in the management of button battery ingestion. 12 Button batteries that have passed the esophagus need not be retrieved in the asymptomatic patient unless the cell is not passing through the pylorus after 48 h of observation. This is rarely the case unless the battery is of large diameter and the patient is under 6 years of age. In this case, endoscopic retrieval is again the preferred option. Most batteries pass completely through the body within 48 to 72 h, although passage has been reported to take as long as 14 days. All patients with signs and symptoms of gastrointestinal tract injury require immediate surgical consultation. Assistance with cell identification may be obtained by calling the National Button Battery Ingestion Hotline (National Capital Poison Center, Washington D.C.) at 202-625-3333.
FIG. 72-1. Algorithm for management of button battery ingestion. (Adapted from Kuhns DW, Dire DJ: Button battery ingestions. Ann Emerg Med 18:293, 1989.) *Button batteries in the esophagus must be removed. Endoscopy should be used if available. The balloon catheter technique can be used if the ingestion is less than 2 h old, but should not be used after this because it may increase the amount of damage to the weakened esophagus.
fWhen the Foley technique fails or is contraindicated due to a greater than 2 h elapsed time period, the button battery should be removed endoscopically. This may require transfer of the patient.
tAcute abdomen, tarry or bloody stools, fever, persistent vomiting.
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