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Foreign Body Ingestion — Button Battery Ingestion Confirmed By X-Ray — Clinical Pathway: Emergency, ICU and Inpatient

Pathway for the Evaluation/Treatment of the Child with Foreign Body Ingestion

Button Battery Ingestion Confirmed By X-Ray
Esophageal Batteries
Emergent Endoscopic Removal
Stomach/Beyond Stomach
 
 
Consult GI
Evaluate Symptoms
  • Anorexia, vomiting
  • Abdominal pain
  • Fever
  • Magnet co-ingestion
 
 
 
 
No Symptoms
Single battery
No magnet co-ingestion
Symptoms
Multiple batteries
Magnet co-ingestion
 
 
 
 
 
 
Battery ≥ 15 mm
Battery < 15 mm
Admit GI
 
 
 
 
 
 
Evaluation of Esophagus
 
 
Esophagram
Urgent Endoscopic Removal
Surgical consult if object not within reach
 
 
Abnormal
Normal
 
 
 
 
Admit GI
Discharge
Discharge
  • Confirm ability to PO
  • Repeat X-ray every 2-3 days until battery passed (PCP or GI)
  • Return to ED if symptomatic
  • Repeat X-ray in 10-14 days if not passed
    (PCP or GI)
  • Return to ED if symptomatic
Esophageal Batteries
  • Serious burns can occur within 2 hrs of ingestion
  • Symptoms may be delayed
  • If mucosal injury is present after removal, observe for delayed complications (esophageal perforation, TEF, vocal cord paralysis, tracheal stenosis, mediastinitis, aspiration pneumonia, perforation into a large vessel)
  • Complications may be delayed weeks, months
Risk Factors for Severe Esophageal Injury Include:
  • Ingested batteries ≥ 20 mm in diameter
  • Children < 6 yrs of age
  • Multiple battery ingestions
  • Esophageal exposure time > 2 hrs
Battery Facts
  • Lithium cell batteries are most frequently involved in esophageal injuries
  • Determination of battery diameter prior to removal or passage is unlikely in at least 40% of cases
  • Assume hearing aid batteries are < 12 mm
  • X-ray overestimates the diameter
 

 

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