In the case above, this child has had prior similar episodes with this non specific symptom. The key factor that lead to prompting further diagnostics was a change in character/severity of the symptoms. The father had reported new onset drooling and prolonged duration of symptoms.

A button battery ingestion may present subtly, especially if it was an unwitnessed event as in this case. Patients with these types of ingestions may be asymptomatic initially and may present with nonspecific symptoms to include dysphagia, nausea, vomiting, chest pain, drooling, difficulty breathing, and stridor.

The patient from this case looked well, but would have likely rapidly deteriorated if a high index of suspicion was not maintained.

After ingestion, the button battery comes in contact with the mucosa of the GI tract, causing hydrolysis and the formation of hydroxide solution, resulting in surrounding alkalinization and liquefactive necrosis.

The negative pole (anode) of the button battery is the side where a reduction reaction takes place, leading to the accumulation of hydrogen gas and hydroxide ions . Often times this side is referred to as the anode, or the negative pole. However, often times when these batteries are immersed in solution, the poles can be redefined, depending where the reduction or oxidation process occurs. Thus, for the proposes of identifying the side of the battery where injury is likely to be worse, clinicians should refer to the site of reduction (site where hydroxide ions accumulate, as the negative pole. An anode facing anteriorly places a higher risk of formation of a tracheoesophageal fistula.

Complications of button battery ingestion include:

– Tracheoesophageal fistula

– Esophageal perforation

– Mediastinitis

– Vocal cord paralysis

– Tracheal stenosis

– Tracheomalacia

– Aspiration pneumonia

– Empyema

– Lung abscess

– Pneumothorax

– Spondylodiscitis

– Large vessel perforation and exsanguination

• As with any foreign body ingestion always ensure that the patient has a patent airway, breathing is not compromised, and circulation is intact. As there is potential for severe damage to mediastinal structures, be prepared to secure an emergent airway if needed.
• When suspected, immediate radiographic imaging should be obtained – Ideally an AP and lateral XR of neck, chest and abdomen. Or, if the patient is small enough, a single ‘babygram.’
• The main goal of esophageal button battery ingestion is endoscopic removal as soon as possible, ideally within 1 hour of presentation to the emergency department.
• Avoid inducing vomiting.
• Don’t try remove it blindly! Direct visualization of adjacent tissues is needed to assess the extent of injuries
• Patients should be NPO for OR, however consider honey or Carafate (see below) depending on your anticipated time to removal. 
• The administration of honey (if >12 mo)  or Carafate has been shown to reduce the severity of injury from button battery ingestion both in vitro and in vivo, and should be strongly considered..
• Anticipate admission to the ICU for these patients for careful monitoring and potential for serial endoscopy and/or bronchoscopy.