Button (or disk) batteries are commonly used in a wide range of household electronics. Over recent decades, the growing demand for compact devices has led to increased use of both larger and more powerful batteries. As a result, cases of button battery ingestion have become more frequent. These batteries can cause serious harm if swallowed or inhaled, particularly in young children, who account for most incidents. While most ingestions are not harmful, some can lead to severe complications involving the esophagus, airway, or nearby nerves and structures. Fortunately, over 97% of cases result in minimal or no symptoms.
Epidemiology
Between 1985 and 2009, the National Poison Data System recorded 56,535 cases of button battery ingestion. Of these, 68.1% involved children under six years old, and 20.3% involved those aged 6 to 19. Each year, U.S. Poison Control Centers receive reports of over 3,300 such cases. The highest rates of ingestion occur in children younger than six, especially between the ages of one and three. In most cases, the ingestion is not witnessed, and over half happen within 30 minutes of the battery being removed from its device.
A secondary peak in ingestion is observed among older adults, particularly those aged 60 to 89, who account for approximately 10% of cases. In this group, batteries are more often found lodged in the intestines. There is also a slight male predominance among reported cases.
Over the past decade, the rate of serious injuries and fatalities from button battery ingestion has risen nearly sevenfold. This trend does not appear to be due to a higher overall ingestion rate but rather to the increased use of larger, more powerful batteries that pose greater risks.
Anatomy
Pathophysiology
Multiple mechanisms have been proposed to explain the injuries caused by disk battery ingestion. These include pressure-induced tissue damage, chemical burns from battery leakage, heavy metal toxicity, and electrical injury. Of these, electrical damage is believed to play the most significant role. When a battery enters the acidic environment of the gastrointestinal (GI) tract, it triggers an electrochemical reaction, particularly at the cathode often near the crimping site. This reaction produces an electric current that drives electrolysis, leading to liquefactive necrosis of surrounding tissues.
Batteries that remain in the stomach for over 48 hours are prone to corrosion and fragmentation. Around 3% of ingested batteries break apart within the GI tract, and 10% show significant cathode erosion. Batteries containing mercuric oxide tend to fragment more readily than those with other chemical makeups.
Serious complications can also arise when batteries become lodged in areas like the ear, nose, or GI tract. Among these, the esophagus is the most dangerous location for impaction, as it is associated with the highest risk of severe outcomes. Although batteries that pass through the esophagus usually continue through the GI tract without incident, significant injury can occur in as little as two hours if they remain lodged. The extent of tissue damage is influenced by both the size and type of battery, with lithium batteries posing a higher risk due to their greater electrical capacity. Current evidence suggests that local tissue damage results more from electrical discharge than from leakage of battery contents.
Etiology
Injury can result from either ingestion or inhalation of disk batteries. Although most batteries move through the gastrointestinal tract without causing harm, serious complications arise when they become lodged in areas such as the nasopharynx, oropharynx, trachea, esophagus, or other parts of the GI tract. When this occurs, localized damage may include tissue injury, ulceration, perforation, or the development of fistulas. While some harm may be immediate, delayed injuries are also common, with long-term effects potentially emerging days or even weeks after the initial event and treatment.
Genetics
Prognostic Factors
Clinical History
Age group
Disk battery ingestion most commonly occurs in young children, particularly those aged 6 months to 6 years. The peak incidence is typically seen around 1 to 2 years of age, when children are most likely to explore their environment by putting objects in their mouths. However, cases can occur in older children and even adults with cognitive impairments or psychiatric conditions.
Physical Examination
There are no unique physical exam signs for acute disk battery ingestion. Batteries lodged in the nasal cavity may be directly observed, but in cases where the battery is in the esophagus or further down the GI tract, physical exam findings are usually normal. In cases with a delayed presentation, examination results may differ significantly depending on the location of the injury.
Age group
Associated comorbidity
Developmental Delay or Neurodevelopmental Disorders
Psychiatric Illness (in Older Children or Adults)
Pica
Household Activities with Easy Access to Small Electronics
Lack of Supervision or Unsafe Storage
Associated activity
Acuity of presentation
High-Acuity Situations:
Esophageal impaction: Can cause tissue damage within 2 hours, leading to burns, perforation, fistula formation, or even fatal hemorrhage from an aorto-esophageal fistula.
Large or lithium batteries (>20 mm): Pose a higher risk, particularly in children under 6 years.
Multiple ingestions or ingestion with magnets: Increases the risk of complications.
Symptoms Indicating High Acuity:
Drooling
Vomiting
Chest pain
Coughing or choking
Difficulty swallowing or refusal to eat
Unexplained fever, irritability, or lethargy
Low-Acuity or Asymptomatic Cases:
Batteries that have passed into the stomach or intestines and are progressing normally on imaging.
These cases may be managed conservatively with observation and serial imaging unless symptoms develop.
Differential Diagnoses
The diagnosis is typically clear, but disk batteries can sometimes be confused with coins or EKG leads on plain X-rays.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The initial management of button battery ingestion involves assessing the patient’s age, the type and size of the battery, the time of ingestion, and its current location. For low-risk, asymptomatic patients with batteries that have passed through the esophagus, the risk of significant complications is minimal. Current national guidelines (NBIH and Button Battery Taskforce) recommend observation with serial radiographs at 10-14 days for these patients. In higher-risk cases such as children under six years old or those with batteries 15 mm or larger repeat imaging should be performed after 4 days, and endoscopic removal should be considered for batteries that have not passed into the stomach. Early endoscopy is advised for high-risk patients (younger than 5 years or batteries >20 mm) to assess for potential esophageal injury that might occur during battery passage. For all other patients, urgent endoscopic removal is necessary.
When considering the appropriate location for endoscopy, particularly if there is a risk of bleeding or difficulty removing the battery, the cardiac catheterization lab or a general operating room with advanced imaging capabilities may be the best settings, as these offer the option to transition to open surgery if required. Given the potential for severe injury from prolonged impaction, cases of button battery ingestion should be prioritized. Coordination with medical and surgical specialists is crucial for each case. Special attention must be given to the battery’s location, especially in relation to major blood vessels such as the aorta. Angiography may be considered if vascular injury is suspected. Post-removal endoscopy can help assess the extent of any injuries and potential complications.
If the battery is lodged in the esophagus, removal should occur within 2 hours to prevent significant tissue damage (necrosis, perforation, or fistula formation).
The battery is removed via flexible endoscopy under sedation. Special care is taken to avoid further injury to surrounding tissues.
If Endoscopy is Unavailable:
Consider surgical removal or referral to a specialized center.
Non-Emergent Management (Stomach or Beyond)
Asymptomatic or Stable Case:
If the battery is beyond the esophagus and the patient is asymptomatic, observe and monitor for progression.
Serial X-rays should be performed to track the battery’s movement through the GI tract.
If the battery does not pass after 48 hours or if symptoms worsen, consider endoscopic retrieval.
If Symptoms Develop:
If the battery causes obstruction, perforation, or is in the intestines, removal is necessary, either via endoscopy or surgery.
role-of-management-for-disk-battery-indigestion
Initial Assessment
Take history, check symptoms, assess airway and vitals.
Imaging & Diagnosis
X-rays to locate battery; look for “double ring” sign.
Emergency vs. Non-Emergency Decision
Esophageal: Urgent endoscopic removal within 2 hours.
Gastric or beyond: Monitor if asymptomatic; remove if large, symptomatic, or no progression.
Post-Removal Care
Monitor for complications (burns, perforation, fistula).
Button (or disk) batteries are commonly used in a wide range of household electronics. Over recent decades, the growing demand for compact devices has led to increased use of both larger and more powerful batteries. As a result, cases of button battery ingestion have become more frequent. These batteries can cause serious harm if swallowed or inhaled, particularly in young children, who account for most incidents. While most ingestions are not harmful, some can lead to severe complications involving the esophagus, airway, or nearby nerves and structures. Fortunately, over 97% of cases result in minimal or no symptoms.
Between 1985 and 2009, the National Poison Data System recorded 56,535 cases of button battery ingestion. Of these, 68.1% involved children under six years old, and 20.3% involved those aged 6 to 19. Each year, U.S. Poison Control Centers receive reports of over 3,300 such cases. The highest rates of ingestion occur in children younger than six, especially between the ages of one and three. In most cases, the ingestion is not witnessed, and over half happen within 30 minutes of the battery being removed from its device.
A secondary peak in ingestion is observed among older adults, particularly those aged 60 to 89, who account for approximately 10% of cases. In this group, batteries are more often found lodged in the intestines. There is also a slight male predominance among reported cases.
Over the past decade, the rate of serious injuries and fatalities from button battery ingestion has risen nearly sevenfold. This trend does not appear to be due to a higher overall ingestion rate but rather to the increased use of larger, more powerful batteries that pose greater risks.
Multiple mechanisms have been proposed to explain the injuries caused by disk battery ingestion. These include pressure-induced tissue damage, chemical burns from battery leakage, heavy metal toxicity, and electrical injury. Of these, electrical damage is believed to play the most significant role. When a battery enters the acidic environment of the gastrointestinal (GI) tract, it triggers an electrochemical reaction, particularly at the cathode often near the crimping site. This reaction produces an electric current that drives electrolysis, leading to liquefactive necrosis of surrounding tissues.
Batteries that remain in the stomach for over 48 hours are prone to corrosion and fragmentation. Around 3% of ingested batteries break apart within the GI tract, and 10% show significant cathode erosion. Batteries containing mercuric oxide tend to fragment more readily than those with other chemical makeups.
Serious complications can also arise when batteries become lodged in areas like the ear, nose, or GI tract. Among these, the esophagus is the most dangerous location for impaction, as it is associated with the highest risk of severe outcomes. Although batteries that pass through the esophagus usually continue through the GI tract without incident, significant injury can occur in as little as two hours if they remain lodged. The extent of tissue damage is influenced by both the size and type of battery, with lithium batteries posing a higher risk due to their greater electrical capacity. Current evidence suggests that local tissue damage results more from electrical discharge than from leakage of battery contents.
Injury can result from either ingestion or inhalation of disk batteries. Although most batteries move through the gastrointestinal tract without causing harm, serious complications arise when they become lodged in areas such as the nasopharynx, oropharynx, trachea, esophagus, or other parts of the GI tract. When this occurs, localized damage may include tissue injury, ulceration, perforation, or the development of fistulas. While some harm may be immediate, delayed injuries are also common, with long-term effects potentially emerging days or even weeks after the initial event and treatment.
Age group
Disk battery ingestion most commonly occurs in young children, particularly those aged 6 months to 6 years. The peak incidence is typically seen around 1 to 2 years of age, when children are most likely to explore their environment by putting objects in their mouths. However, cases can occur in older children and even adults with cognitive impairments or psychiatric conditions.
There are no unique physical exam signs for acute disk battery ingestion. Batteries lodged in the nasal cavity may be directly observed, but in cases where the battery is in the esophagus or further down the GI tract, physical exam findings are usually normal. In cases with a delayed presentation, examination results may differ significantly depending on the location of the injury.
Developmental Delay or Neurodevelopmental Disorders
Psychiatric Illness (in Older Children or Adults)
Pica
Household Activities with Easy Access to Small Electronics
Lack of Supervision or Unsafe Storage
High-Acuity Situations:
Esophageal impaction: Can cause tissue damage within 2 hours, leading to burns, perforation, fistula formation, or even fatal hemorrhage from an aorto-esophageal fistula.
Large or lithium batteries (>20 mm): Pose a higher risk, particularly in children under 6 years.
Multiple ingestions or ingestion with magnets: Increases the risk of complications.
Symptoms Indicating High Acuity:
Drooling
Vomiting
Chest pain
Coughing or choking
Difficulty swallowing or refusal to eat
Unexplained fever, irritability, or lethargy
Low-Acuity or Asymptomatic Cases:
Batteries that have passed into the stomach or intestines and are progressing normally on imaging.
These cases may be managed conservatively with observation and serial imaging unless symptoms develop.
The diagnosis is typically clear, but disk batteries can sometimes be confused with coins or EKG leads on plain X-rays.
The initial management of button battery ingestion involves assessing the patient’s age, the type and size of the battery, the time of ingestion, and its current location. For low-risk, asymptomatic patients with batteries that have passed through the esophagus, the risk of significant complications is minimal. Current national guidelines (NBIH and Button Battery Taskforce) recommend observation with serial radiographs at 10-14 days for these patients. In higher-risk cases such as children under six years old or those with batteries 15 mm or larger repeat imaging should be performed after 4 days, and endoscopic removal should be considered for batteries that have not passed into the stomach. Early endoscopy is advised for high-risk patients (younger than 5 years or batteries >20 mm) to assess for potential esophageal injury that might occur during battery passage. For all other patients, urgent endoscopic removal is necessary.
When considering the appropriate location for endoscopy, particularly if there is a risk of bleeding or difficulty removing the battery, the cardiac catheterization lab or a general operating room with advanced imaging capabilities may be the best settings, as these offer the option to transition to open surgery if required. Given the potential for severe injury from prolonged impaction, cases of button battery ingestion should be prioritized. Coordination with medical and surgical specialists is crucial for each case. Special attention must be given to the battery’s location, especially in relation to major blood vessels such as the aorta. Angiography may be considered if vascular injury is suspected. Post-removal endoscopy can help assess the extent of any injuries and potential complications.
Emergency Medicine
Secure Storage
Store batteries in childproof containers and keep them out of reach and sight of children.
Keep spare and used batteries locked away or in high cabinets.
Battery-Operated Device Safety
Ensure battery compartments on devices are screw-secured or taped shut.
Avoid giving children access to devices with easily opened battery compartments, such as remote controls, toys, or musical cards.
Disposal Practices
Safely dispose of used batteries immediately in a childproof, closed container.
Do not leave used batteries lying around on counters, tables, or trash bins.
Supervision and Education
Supervise young children during play, especially with electronic toys or household gadgets.
Educate older children not to remove or play with batteries.
Product Choices
Choose battery-powered products labeled as child-resistant.
Support or advocate for regulations requiring tamper-resistant battery compartments in consumer electronics.
Emergency Medicine
Emergency Management (Esophageal Ingestion)
Urgent Endoscopic Removal:
If the battery is lodged in the esophagus, removal should occur within 2 hours to prevent significant tissue damage (necrosis, perforation, or fistula formation).
The battery is removed via flexible endoscopy under sedation. Special care is taken to avoid further injury to surrounding tissues.
If Endoscopy is Unavailable:
Consider surgical removal or referral to a specialized center.
Non-Emergent Management (Stomach or Beyond)
Asymptomatic or Stable Case:
If the battery is beyond the esophagus and the patient is asymptomatic, observe and monitor for progression.
Serial X-rays should be performed to track the battery’s movement through the GI tract.
If the battery does not pass after 48 hours or if symptoms worsen, consider endoscopic retrieval.
If Symptoms Develop:
If the battery causes obstruction, perforation, or is in the intestines, removal is necessary, either via endoscopy or surgery.
Emergency Medicine
Initial Assessment
Take history, check symptoms, assess airway and vitals.
Imaging & Diagnosis
X-rays to locate battery; look for “double ring” sign.
Emergency vs. Non-Emergency Decision
Esophageal: Urgent endoscopic removal within 2 hours.
Gastric or beyond: Monitor if asymptomatic; remove if large, symptomatic, or no progression.
Post-Removal Care
Monitor for complications (burns, perforation, fistula).
Button (or disk) batteries are commonly used in a wide range of household electronics. Over recent decades, the growing demand for compact devices has led to increased use of both larger and more powerful batteries. As a result, cases of button battery ingestion have become more frequent. These batteries can cause serious harm if swallowed or inhaled, particularly in young children, who account for most incidents. While most ingestions are not harmful, some can lead to severe complications involving the esophagus, airway, or nearby nerves and structures. Fortunately, over 97% of cases result in minimal or no symptoms.
Between 1985 and 2009, the National Poison Data System recorded 56,535 cases of button battery ingestion. Of these, 68.1% involved children under six years old, and 20.3% involved those aged 6 to 19. Each year, U.S. Poison Control Centers receive reports of over 3,300 such cases. The highest rates of ingestion occur in children younger than six, especially between the ages of one and three. In most cases, the ingestion is not witnessed, and over half happen within 30 minutes of the battery being removed from its device.
A secondary peak in ingestion is observed among older adults, particularly those aged 60 to 89, who account for approximately 10% of cases. In this group, batteries are more often found lodged in the intestines. There is also a slight male predominance among reported cases.
Over the past decade, the rate of serious injuries and fatalities from button battery ingestion has risen nearly sevenfold. This trend does not appear to be due to a higher overall ingestion rate but rather to the increased use of larger, more powerful batteries that pose greater risks.
Multiple mechanisms have been proposed to explain the injuries caused by disk battery ingestion. These include pressure-induced tissue damage, chemical burns from battery leakage, heavy metal toxicity, and electrical injury. Of these, electrical damage is believed to play the most significant role. When a battery enters the acidic environment of the gastrointestinal (GI) tract, it triggers an electrochemical reaction, particularly at the cathode often near the crimping site. This reaction produces an electric current that drives electrolysis, leading to liquefactive necrosis of surrounding tissues.
Batteries that remain in the stomach for over 48 hours are prone to corrosion and fragmentation. Around 3% of ingested batteries break apart within the GI tract, and 10% show significant cathode erosion. Batteries containing mercuric oxide tend to fragment more readily than those with other chemical makeups.
Serious complications can also arise when batteries become lodged in areas like the ear, nose, or GI tract. Among these, the esophagus is the most dangerous location for impaction, as it is associated with the highest risk of severe outcomes. Although batteries that pass through the esophagus usually continue through the GI tract without incident, significant injury can occur in as little as two hours if they remain lodged. The extent of tissue damage is influenced by both the size and type of battery, with lithium batteries posing a higher risk due to their greater electrical capacity. Current evidence suggests that local tissue damage results more from electrical discharge than from leakage of battery contents.
Injury can result from either ingestion or inhalation of disk batteries. Although most batteries move through the gastrointestinal tract without causing harm, serious complications arise when they become lodged in areas such as the nasopharynx, oropharynx, trachea, esophagus, or other parts of the GI tract. When this occurs, localized damage may include tissue injury, ulceration, perforation, or the development of fistulas. While some harm may be immediate, delayed injuries are also common, with long-term effects potentially emerging days or even weeks after the initial event and treatment.
Age group
Disk battery ingestion most commonly occurs in young children, particularly those aged 6 months to 6 years. The peak incidence is typically seen around 1 to 2 years of age, when children are most likely to explore their environment by putting objects in their mouths. However, cases can occur in older children and even adults with cognitive impairments or psychiatric conditions.
There are no unique physical exam signs for acute disk battery ingestion. Batteries lodged in the nasal cavity may be directly observed, but in cases where the battery is in the esophagus or further down the GI tract, physical exam findings are usually normal. In cases with a delayed presentation, examination results may differ significantly depending on the location of the injury.
Developmental Delay or Neurodevelopmental Disorders
Psychiatric Illness (in Older Children or Adults)
Pica
Household Activities with Easy Access to Small Electronics
Lack of Supervision or Unsafe Storage
High-Acuity Situations:
Esophageal impaction: Can cause tissue damage within 2 hours, leading to burns, perforation, fistula formation, or even fatal hemorrhage from an aorto-esophageal fistula.
Large or lithium batteries (>20 mm): Pose a higher risk, particularly in children under 6 years.
Multiple ingestions or ingestion with magnets: Increases the risk of complications.
Symptoms Indicating High Acuity:
Drooling
Vomiting
Chest pain
Coughing or choking
Difficulty swallowing or refusal to eat
Unexplained fever, irritability, or lethargy
Low-Acuity or Asymptomatic Cases:
Batteries that have passed into the stomach or intestines and are progressing normally on imaging.
These cases may be managed conservatively with observation and serial imaging unless symptoms develop.
The diagnosis is typically clear, but disk batteries can sometimes be confused with coins or EKG leads on plain X-rays.
The initial management of button battery ingestion involves assessing the patient’s age, the type and size of the battery, the time of ingestion, and its current location. For low-risk, asymptomatic patients with batteries that have passed through the esophagus, the risk of significant complications is minimal. Current national guidelines (NBIH and Button Battery Taskforce) recommend observation with serial radiographs at 10-14 days for these patients. In higher-risk cases such as children under six years old or those with batteries 15 mm or larger repeat imaging should be performed after 4 days, and endoscopic removal should be considered for batteries that have not passed into the stomach. Early endoscopy is advised for high-risk patients (younger than 5 years or batteries >20 mm) to assess for potential esophageal injury that might occur during battery passage. For all other patients, urgent endoscopic removal is necessary.
When considering the appropriate location for endoscopy, particularly if there is a risk of bleeding or difficulty removing the battery, the cardiac catheterization lab or a general operating room with advanced imaging capabilities may be the best settings, as these offer the option to transition to open surgery if required. Given the potential for severe injury from prolonged impaction, cases of button battery ingestion should be prioritized. Coordination with medical and surgical specialists is crucial for each case. Special attention must be given to the battery’s location, especially in relation to major blood vessels such as the aorta. Angiography may be considered if vascular injury is suspected. Post-removal endoscopy can help assess the extent of any injuries and potential complications.
Emergency Medicine
Secure Storage
Store batteries in childproof containers and keep them out of reach and sight of children.
Keep spare and used batteries locked away or in high cabinets.
Battery-Operated Device Safety
Ensure battery compartments on devices are screw-secured or taped shut.
Avoid giving children access to devices with easily opened battery compartments, such as remote controls, toys, or musical cards.
Disposal Practices
Safely dispose of used batteries immediately in a childproof, closed container.
Do not leave used batteries lying around on counters, tables, or trash bins.
Supervision and Education
Supervise young children during play, especially with electronic toys or household gadgets.
Educate older children not to remove or play with batteries.
Product Choices
Choose battery-powered products labeled as child-resistant.
Support or advocate for regulations requiring tamper-resistant battery compartments in consumer electronics.
Emergency Medicine
Emergency Management (Esophageal Ingestion)
Urgent Endoscopic Removal:
If the battery is lodged in the esophagus, removal should occur within 2 hours to prevent significant tissue damage (necrosis, perforation, or fistula formation).
The battery is removed via flexible endoscopy under sedation. Special care is taken to avoid further injury to surrounding tissues.
If Endoscopy is Unavailable:
Consider surgical removal or referral to a specialized center.
Non-Emergent Management (Stomach or Beyond)
Asymptomatic or Stable Case:
If the battery is beyond the esophagus and the patient is asymptomatic, observe and monitor for progression.
Serial X-rays should be performed to track the battery’s movement through the GI tract.
If the battery does not pass after 48 hours or if symptoms worsen, consider endoscopic retrieval.
If Symptoms Develop:
If the battery causes obstruction, perforation, or is in the intestines, removal is necessary, either via endoscopy or surgery.
Emergency Medicine
Initial Assessment
Take history, check symptoms, assess airway and vitals.
Imaging & Diagnosis
X-rays to locate battery; look for “double ring” sign.
Emergency vs. Non-Emergency Decision
Esophageal: Urgent endoscopic removal within 2 hours.
Gastric or beyond: Monitor if asymptomatic; remove if large, symptomatic, or no progression.
Post-Removal Care
Monitor for complications (burns, perforation, fistula).
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