Button battery ingestion is a medical emergency requiring immediate action, as severe injury can begin within minutes. If ingestion is suspected, caregivers must immediately call 911 or the National Battery Ingestion Hotline and proceed to the nearest emergency department. Delaying treatment significantly increases the risk of devastating and potentially fatal complications.
The Mechanism of Injury and Rapid Damage Timeline
The danger of a button battery lodged in the esophagus stems from an electrochemical reaction. When the battery becomes stuck in moist tissue, it completes an electrical circuit. This current hydrolyzes water in the tissue and saliva, quickly generating highly corrosive hydroxide ions at the battery’s negative pole.
These hydroxide ions create a powerful alkaline burn, similar to lye, leading to liquefaction necrosis. Unlike acid burns, this alkaline injury progressively dissolves the tissue, allowing damage to penetrate deeply into the esophageal wall. Tissue injury can begin in 15 minutes after impaction. Full-thickness burns and potential perforation can occur within two hours. Even after removal, the injury may continue to progress for days or weeks due to residual alkaline damage.
Immediate Emergency Protocol for Caregivers
Immediate transport to an emergency facility with pediatric and surgical capabilities is necessary. Do not attempt to induce vomiting, as this offers no benefit and risks aspiration. Unless instructed otherwise, the child should not eat or drink, as this could complicate the endoscopic procedure.
If the child is over 12 months old, can swallow, and the ingestion occurred within 12 hours, commercial honey may be administered while en route. Honey can coat the battery, potentially slowing tissue damage by buffering the hydroxide ions. The recommended dose is 10 milliliters (about two teaspoons) every 10 minutes, for up to six doses. This measure only mitigates injury and is not a substitute for immediate medical care and urgent removal.
Symptoms, Diagnosis, and Medical Removal
Symptoms following button battery ingestion are often vague and easily mistaken for a common cold, contributing to delays in diagnosis. Common signs include drooling, refusal to eat or drink, coughing, fever, chest discomfort, or gagging with swallowing. In unwitnessed cases, these symptoms can persist for days or weeks before severe complications manifest.
Diagnosis requires a STAT X-ray of the neck, chest, and abdomen to confirm the object’s location. A button battery lodged in the esophagus appears as a circular, opaque foreign body. It is distinguished from a coin by the characteristic “double-ring” or “halo” sign on the X-ray, created by the battery’s internal structure. A coin presents as a uniformly dense object.
If the X-ray confirms the battery is lodged in the esophagus, immediate endoscopic removal is mandatory, regardless of the patient’s symptoms or the time of ingestion. The battery is removed via urgent endoscopy under general anesthesia. Following removal, the injury site is often irrigated with a dilute sterile vinegar solution (0.25% acetic acid) to neutralize any remaining alkaline residue and halt tissue damage progression. If the battery has passed into the stomach, it is usually allowed to pass naturally unless it is larger than 20 millimeters or the child develops symptoms.
Potential Complications and Long-Term Recovery
Injuries can worsen even after the battery is removed due to the chemical burn. Serious complications include an esophageal stricture (narrowing due to scar tissue) or a tracheoesophageal fistula (an abnormal connection between the esophagus and the windpipe). The most feared complication is an aortoesophageal fistula, where the burn erodes into the aorta, which is frequently fatal.
Long-term management focuses on monitoring for these delayed issues, especially strictures, which can form weeks or months after the initial event. Patients with significant mucosal injury require close observation and often a repeat endoscopy or a contrast swallow study (esophagram) four weeks after removal. If a stricture develops, it may require serial endoscopic dilations to stretch the narrowed area and restore normal swallowing.