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Foreign Body Ingestion in Children: Should Button Batteries in the Stomach Be Urgently Removed?

Lee JH, Lee JH, Shim JO, Lee JH, Eun BL, Yoo KH - Pediatr Gastroenterol Hepatol Nutr (2016)

Bottom Line: We investigated patient age, shape, size, location of FBs, spontaneous passage time and resulting complications among 76 children.Their shapes and sizes were not associated with the spontaneous passage time.Size, spontaneous passage time, and age were also not associated with any specific complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Foreign body (FB) ingestion is common in children, and button battery (BB) ingestion has been increasing in recent years. This study was to identify factors related to outcomes of FB ingestion, particularly BBs in the stomach. We evaluated whether the current recommendations are appropriate and aimed to suggest indications for endoscopic removal of BB in the stomach in young children.

Methods: We investigated patient age, shape, size, location of FBs, spontaneous passage time and resulting complications among 76 children. We observed types, size, location of BB and outcomes, and analyzed their associations with complications.

Results: Coins and BB were the two most common FBs. Their shapes and sizes were not associated with the spontaneous passage time. Size, spontaneous passage time, and age were also not associated with any specific complications. For BB ingestion, all 5 cases with lithium batteries (≥1.5 cm, 3 V) presented moderate to major complications in the esophagus and stomach without any symptoms, even when the batteries were in the stomach and beyond the duodenum, while no complications were noted in 7 cases with alkaline batteries (<1.5 cm, 1.5 V) (p=0.001). All endoscopies were conducted within 24 hours after ingestion.

Conclusion: The type and voltage of the battery should be considered when determining whether endoscopy is required to remove a BB in the stomach. For lithium battery ingestion in young children, urgent endoscopic removal might be important in order to prevent complications, even if the child is asymptomatic and the battery is smaller than 2 cm.

No MeSH data available.


Related in: MedlinePlus

Endoscopic fingings of children with lithiuim battery (2.0 cm, 3 V) lodged in the upper esophageal sphincter (UES). The lithium battery was removed from the UES within two hours after ingestion. (A) Mucosal burns and two linear ulcerations with dirty exudate and bleeding were noted in the UES. (B) After five days, a linear deep ulceration with basal whitish exudate and peripheral mucosal edema was remained. A shallow linear ulceration was noted in the opposite side of the esophagus.
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Figure 3: Endoscopic fingings of children with lithiuim battery (2.0 cm, 3 V) lodged in the upper esophageal sphincter (UES). The lithium battery was removed from the UES within two hours after ingestion. (A) Mucosal burns and two linear ulcerations with dirty exudate and bleeding were noted in the UES. (B) After five days, a linear deep ulceration with basal whitish exudate and peripheral mucosal edema was remained. A shallow linear ulceration was noted in the opposite side of the esophagus.

Mentions: Complications were present in 5 (41.7%) of the total 12 children who ingested batteries. In one case, the button battery was located in the UES and was removed within 2 hours, but caused mucosal burns and deep ulcers with bleeding and exudate (Fig. 3). These sequelae remained when the patient was followed up (major complication). Complications were detected in 4 cases in the stomach, including 1 with a major complication and 3 with moderate complications (Fig. 4). Of them, in 1 case, the battery was lodged in the small bowel immediately before the upper endoscopy, but ulcers and erosions were identified in the stomach (moderate complication). The median age of 5 children with complications was 13 months (IQR, 11-35 months), while that of the 7 children without complications was 18 months (IQR, 14-31 months) (p=0.570).


Foreign Body Ingestion in Children: Should Button Batteries in the Stomach Be Urgently Removed?

Lee JH, Lee JH, Shim JO, Lee JH, Eun BL, Yoo KH - Pediatr Gastroenterol Hepatol Nutr (2016)

Endoscopic fingings of children with lithiuim battery (2.0 cm, 3 V) lodged in the upper esophageal sphincter (UES). The lithium battery was removed from the UES within two hours after ingestion. (A) Mucosal burns and two linear ulcerations with dirty exudate and bleeding were noted in the UES. (B) After five days, a linear deep ulceration with basal whitish exudate and peripheral mucosal edema was remained. A shallow linear ulceration was noted in the opposite side of the esophagus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4821979&req=5

Figure 3: Endoscopic fingings of children with lithiuim battery (2.0 cm, 3 V) lodged in the upper esophageal sphincter (UES). The lithium battery was removed from the UES within two hours after ingestion. (A) Mucosal burns and two linear ulcerations with dirty exudate and bleeding were noted in the UES. (B) After five days, a linear deep ulceration with basal whitish exudate and peripheral mucosal edema was remained. A shallow linear ulceration was noted in the opposite side of the esophagus.
Mentions: Complications were present in 5 (41.7%) of the total 12 children who ingested batteries. In one case, the button battery was located in the UES and was removed within 2 hours, but caused mucosal burns and deep ulcers with bleeding and exudate (Fig. 3). These sequelae remained when the patient was followed up (major complication). Complications were detected in 4 cases in the stomach, including 1 with a major complication and 3 with moderate complications (Fig. 4). Of them, in 1 case, the battery was lodged in the small bowel immediately before the upper endoscopy, but ulcers and erosions were identified in the stomach (moderate complication). The median age of 5 children with complications was 13 months (IQR, 11-35 months), while that of the 7 children without complications was 18 months (IQR, 14-31 months) (p=0.570).

Bottom Line: We investigated patient age, shape, size, location of FBs, spontaneous passage time and resulting complications among 76 children.Their shapes and sizes were not associated with the spontaneous passage time.Size, spontaneous passage time, and age were also not associated with any specific complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Foreign body (FB) ingestion is common in children, and button battery (BB) ingestion has been increasing in recent years. This study was to identify factors related to outcomes of FB ingestion, particularly BBs in the stomach. We evaluated whether the current recommendations are appropriate and aimed to suggest indications for endoscopic removal of BB in the stomach in young children.

Methods: We investigated patient age, shape, size, location of FBs, spontaneous passage time and resulting complications among 76 children. We observed types, size, location of BB and outcomes, and analyzed their associations with complications.

Results: Coins and BB were the two most common FBs. Their shapes and sizes were not associated with the spontaneous passage time. Size, spontaneous passage time, and age were also not associated with any specific complications. For BB ingestion, all 5 cases with lithium batteries (≥1.5 cm, 3 V) presented moderate to major complications in the esophagus and stomach without any symptoms, even when the batteries were in the stomach and beyond the duodenum, while no complications were noted in 7 cases with alkaline batteries (<1.5 cm, 1.5 V) (p=0.001). All endoscopies were conducted within 24 hours after ingestion.

Conclusion: The type and voltage of the battery should be considered when determining whether endoscopy is required to remove a BB in the stomach. For lithium battery ingestion in young children, urgent endoscopic removal might be important in order to prevent complications, even if the child is asymptomatic and the battery is smaller than 2 cm.

No MeSH data available.


Related in: MedlinePlus