Question 2: In children with ingested button batteries in the stomach, which patients are at the highest risk for complications?

In September 2016, the National Capital Poison Center revised its treatment guideline and algorithm for button battery ingestion. While in the past it was not uncommon to endoscopically remove button batteries located in the stomach, the National Battery Ingestion Hotline (NBIH) triage and treatment guideline suggests an observation/reevaluation approach for button batteries in the stomach in children who are asymptomatic, particularly if the patient is older than 12 years. While endoscopic removal of esophageal button batteries is standard—even in asymptomatic patients—treatment of the asymptomatic button battery in the stomach may be a little more tricky, and the data are rather limited.

A three-year retrospective study by Lee et al described 12 button battery ingestions with one in the esophagus, five in the stomach, and six distal to the duodenum.¹ The authors report that “none showed any symptoms after the ingestion” and mention that batteries greater than 1.5 cm in diameter or 3V batteries—compared to 1.5V batteries—appear to be a higher risk for moderate to severe complications. While the authors do mention an increase in case studies demonstrating complications in younger children, they state that their study did not find a correlation between age and risk of complications.^2,3

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