[size=20px]A three-year old boy swallows a button battery measuring 12 mm in diameter three hours before presentation. A radiograph shows the battery is in the stomach. The child is completely asymptomatic.

 

The best management for this button battery ingestion is

 

A discharge with instructions to confirm passage of battery.

 

B admission to hospital until the battery is passed.

 

C polyethylene glycol bowel cleanout.

 

D immediate endoscopic retrieval.

 

E operative gastrotomy and retrieval.[/size]

A

A

A

Correct answer

A discharge with instructions to confirm passage of battery.

 

 

The immediacy of endoscopic retrieval of an ingested button battery lodged in the esophagus is well supported. However, if the battery is found distal to the esophagus, the guidelines for management are less clear. Guidelines exist at http://www.poison.gov, but the literature supporting these guidelines is sparse and mainly consists of case reports.

 

Retrieval of disc batteries from the stomach are indicated in the following scenarios

• simultaneous magnet ingestion
  
• development of signs or symptoms possibly attributable to injury caused by the battery
  
• battery (greater than or equal to 15 mm diameter) ingested by a child less than six years old which has remained in the stomach for four days or longer
  
• large battery (greater than 20 mm) in patients younger than five years with a history suggesting prevous prolonged (i.e. greater than two hours) presence of the battery in the esophagus
  

In asymptomatic patients with button batteries in the stomach, discharging the patient on a regular diet and normal activity is considered safe. Parents should watch for symptoms such as abdominal pain, anorexia, vomiting, occult or visible bleeding and signs of an acute abdomen. If possible, parents should confirm battery passage by inspecting stools. If passage not observed in four to five days, repeat radiographs should be performed.