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Imaging button battery ingestions and insertions in children: a 15-year single-center review
Brian S Pugmire1, Tom K Lin2, Scott Pentiuk2
1Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
Insights
Button battery ingestions in children are increasingly serious. Larger batteries (over 20mm) are more likely to cause severe esophageal injury, requiring increased clinical attention.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Emergency Medicine
Background:
- Morbidity associated with pediatric button battery ingestions is rising.
- Early identification and management are crucial for preventing severe complications.
Purpose of the Study:
- To conduct a comprehensive, imaging-focused review of button battery ingestions/insertions in children over 15 years.
- To correlate imaging findings with patient demographics, clinical history, and management outcomes.
Main Methods:
- Retrospective review of radiology reports (2000-2015) for "battery" and "batteries."
- Analysis of imaging studies (radiography, fluoroscopy, CT) for confirmed cases.
- Endoscopic grading of mucosal injuries by pediatric gastroenterologists.
Main Results:
- 276 cases reviewed; radiography was universally used.
- Esophageal batteries (≥20mm) were significantly larger than those passed distally (22.1mm vs. 13.7mm).
- Larger battery diameter (≥20mm) correlated with esophageal impaction and higher-grade injury.
Conclusions:
- Button batteries >20mm diameter require heightened clinical scrutiny due to increased risk and severity of injury.
- Adherence to guidelines will likely increase CT and MRI utilization for pediatric button battery ingestions.
Background:
Recent studies have shown an increase in morbidity associated with button battery ingestions in children.
Objective:
To perform a comprehensive, imaging-focused review of all patients with confirmed button battery ingestions/insertions imaged at our institution in the last 15 years.
Materials And Methods:
Radiology reports from Jan. 1, 2000, to July 12, 2015, were searched for the terms "battery" and "batteries." Confirmed cases of battery ingestion/insertion for which images were available were reviewed. Cases were reviewed for imaging studies performed, imaging findings, patient demographics, clinical history and management. Two pediatric gastroenterologists reviewed endoscopic images and graded mucosal injuries in selected cases.
Results:
Two hundred seventy-six cases were reviewed. All patients were imaged with radiography, 19 with fluoroscopy (6.8%), and 4 with CT (1.4%). Batteries retained in the esophagus (n = 27, 9.8%) were larger in diameter on average than those that had passed distally (22.1 ± 3.3 mm vs. 13.7 ± 1.6 mm, P<0.0001). Battery diameter ≥20 mm was associated with esophageal impaction (P<0.0001) and higher grade esophageal injury (P<0.0001). Mean battery diameter was greater for patients with grade 1 or higher mucosal injury than for patients with no mucosal injury (22.1 ± 2.1 mm vs. 14.7 ± 4.5 mm, P<0.0001). Sixteen percent (4/25) of patients with grade ≥1 esophageal injury had batteries in the stomach on initial imaging. Five patients (1.8%) had serious clinical complications (e.g., esophageal perforation, tracheoesophageal fistula).
Conclusion:
Button batteries >20mm in diameter warrant increased clinical scrutiny due to higher likelihood and severity of injury. Implementation of recent pediatric gastroenterology societal guidelines will likely lead to a substantial increase in the number of CT and MRI examinations.