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Button Battery Injury and swallowed foreign objects

Introduction

Most swallowed foreign objects are harmless and may not need any investigation – just reassurance. Button battery injuries (and to a lesser extent – magents) are uniquely urgent – as the contents can cause burn injuries to surrounding tissues within 15 minutes. Swallowing honey or sucralfate within 12 hours of ingestion can delay the onset of tissue damage whilst awaiting definitive removal (e.g. via endoscopy or surgically).

Button battery injury can occur when a button battery is swallowed (or placed in another orifice – such as the ear, nose, vagina or anus) – usually (but not always!) by a paediatric patient. There are many different types of button battery in many shapes and sizes, but any battery with a voltage of 1.2V or greater can cause injury. Smaller batteries are less likely to cause injury as they can pass through the digestive tract more easily and are less likely to become impacted (get stuck).

Although many cases present as witnessed or suspected ingested button batteries, an unwitnessed event can present with non-specific gastrointestinal and respiratory symptoms, and can be fatal if not recognised.

Most of the damage from button battery injury comes from the electrical current it creates in the tissues that it touches – NOT from leaking of the contents of the battery. Tissue damage occurs within 15 minutes of sustained contact with any piece of tissue.

Therefore – button battery injury is an important time-dependent emergency – tissue damage can occur within minutes when a battery becomes impacted within the gastrointestinal tract (or other tissue).

Less dangerous- but still serious – is when small magnets are swallowed (at least one needs to be swallowed for them to be dangerous). They can stick together with tissue between them causing a pressure injury to the digestive tract. This typically takes much longer than a button battery injury but the consequences can be just as serious. Other foreign objects are generally less dangerous and most can be allowed to make their own way through the digestive tract. It is often appropriate to perform an x-ray to assess the location of the foreign object – large objects that remain in the stomach may need to be retrieved via gastroscope as they will not pass naturally. Objects that have already moved beyond the stomach usually cannot be retrieved and should be allowed to pass naturally, unless an emergency arises. Also consider than some foreign objects may be toxic and consider contacting poisons information.

In Australia (population is about 35% that of the UK) there are about 200 button battery injuries per year (about 5–10% of these are serious) and on average about one death every 3 years.

A selection of metallic monopoy pieces

One particularly memorable clinical incident was when a psychiatric patient swallowed an entire set of metallic monopoly pieces. This made for a great x-ray – Dr Tom Leach

Epidemiology & Aetiology

Pathophysiology

Button battery injury demonstrated with a pieces of meat. (A) shows the damage after 15 minutes and (B) after 2 hours. Image from RACGP – https://www1.racgp.org.au/ajgp/2022/july/button-battery-injury

 

Presentation

Investigations

X-ray is the diagnostic imaging modality of choice

Management

Management is time critical. 

In other orifices

Complications

Long-term complications can be significant, although are rate. These are typically strictures or fistula formation – for example oesophageal stricture, tracheo-oesophageal structure, tracheal stenosis.

Prevention

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