Disc Battery Ingestion Hazardous for Children
Children often swallow objects they shouldn’t. Disc batteries can cause serious esophageal damage when swallowed by children.
Stanley J. Kimball, DO, of Mount Carmel Health System in Columbus, Ohio, and colleagues report the damage to the esophagus can occur within a short time, urging emergency esophagoscopy (use of a thin scope with a light to exam the esophagus under direct vision) if a disc battery is seen on a chest x-ray.
Their report have published the report of their small study in the September Archives of Otolaryngology-Head & Neck Surgery. The study is a retrospective chart review of only ten patients, of which seven experienced extensive esophageal damage after ingestion of a battery.
The children ranged in age from 9.5 months to 9.5 years (mean age 3.2 years). The length of hospital stays ranged from one day to an entire month (mean stay 6.9 days. Each child had a plain chest x-ray; one child also underwent a chest computed tomographic (CT) scan.
Symptoms and presentation varied. Five of the children were seen ingesting the battery or were found coughing. Two children complained of a sore throat and self-reported FB ingestion. Three patients were diagnosed incidentally via chest x-ray. Two of these delayed presentations included persistent upper respiratory tract symptoms. One was discovered by sheer accident during a workup for chest and back pain after the child falling off her bike.
Most of the children (8/10) were seen within 12 hours of ingestion. Two patients had a substantial delay in discovery of the disc: 7 days and 30 days after ingestion.
The use of disc batteries continues to increase in our electronic age. The batteries are used in hearing aids, cameras, watches, and calculators. The batteries can cause damage to the body by leaking alkaline contents causing a liquefactive necrosis, electrical discharge leading to low-voltage burns, and pressure necrosis.
Along with the increase in use, has come the increased number of reported disc battery ingestions by children. In 1998, the American Association of Poison Control Centers reported a total of 2063 disc battery ingestions. This number increased 80% over the next 8 years.
Kimball and colleagues note the injuries from disc battery ingestion can occur very quickly. Two of their patients were seen within three hours of accidentally swallowing the battery and were found to have severe erosion and transmural necrosis of their esophagus. Another child seen within four hours of ingesting a battery had developed esophageal stenosis.
Eight of the 10 children underwent direct laryngoscopy, bronchoscopy, and esophagoscopy with FB retrieval. The other 2 children underwent rigid esophagoscopy with FB removal.
Three children had minimal esophageal damage. The other 7 children had more severe and extensive esophageal damage involving the muscularis (n = 5) or resulting in perforation (n = 2). One of these children had an extensive injury that extended into the trachea resulting in a tracheoesophageal fistula.
Kimball and colleagues recommended all children with suspected disc battery ingestion should have an emergency esophagoscopy when a disc battery is identified on chest radiography.
Parents and caregivers should be careful to keep disc batteries out of reach of children to prevent accidental ingestion.
Kimball S, et al "A review of esophageal disc battery ingestions and a protocol for management" Arch Otolaryngol Head Neck Surg 2010; 136: 866-871.