Review Question - QID 105410

This patient has ingested a disc-battery, with imaging demonstrating that the battery is currently lodged in the esophagus. Immediate endoscopic removal is warranted, as mucosal injury to the GI tract can often occur rapidly with these ingestions.

Complications of a button battery in the esophagus include esophageal perforation and development of a tracheoesophageal fistula. While witnessed ingestions allow for immediate identification and management of the ingested foreign body, many foreign body ingestions in children are not witnessed. Clinical symptoms should guide evaluation. Initial imaging with radiographs is appropriate in identifying radiopaque objects. A button battery appears on radiographs as a thin bilaminar disc, with one side slightly smaller in diameter than the other. It requires immediate removal as the battery can discharge and cause necrosis.

Figure/Illustration A shows a radiograph of a disc battery (red circle) in a patient's esophagus. The coin-shaped disc with a ring inside of it suggests this is a button battery and not a coin or toy regardless of the patient history offered.

Incorrect Answers:
Answer 2: Observation and monitoring only is appropriate management of a small, smooth object that will pass spontaneously through the GI tract. It would not be indicated for a battery, a sharp object, or a large object that will not pass.

Answer 3: Oral fluids to advance the object is generally not a method of advancing an esophageal foreign body as it could cause an aspiration event.

Answer 4: Serial radiographs may be indicated in a well-appearing individual who can tolerate their oral secretions with a non-dangerous object in their esophagus (like a marble).

Answer 5: Surgical removal may be indicated if endoscopic retrieval fails for a button battery.

Bullet Summary:
Button batteries must emergently be removed endoscopically.