Eur J Pediatr Surg 2022; 32(01): 002-008
DOI: 10.1055/s-0041-1740537
Original Article

Evaluation of a Symptom-Based Algorithm for Managing Battery Ingestions in Children

1   Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
,
Kayla B. Briggs
1   Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
,
Wendy Jo Svetanoff
1   Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
,
Thomas M. Attard
2   Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
3   Department of Gastroenterology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
,
Tolulope A. Oyetunji
1   Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
,
Shawn D. St Peter
1   Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
› Author Affiliations

Abstract

Objectives While complications from battery ingestion can be severe, especially with the emergence of stronger battery elements, not all ingestions require prompt removal. We aim to evaluate a symptom-focused algorithm for battery ingestion that emphasizes observation over intervention to investigate its safety.

Materials and Methods Patients were identified through a query of foreign-body ingestion radiographs obtained between 2017 and 2020. A retrospective chart review was then performed of all patients who presented with button battery ingestions to identify compliance with our algorithm, overall outcomes, and complications.

Results In total, 2% of all radiographs (44/2,237) demonstrated button battery ingestions. The median age of patients was 3.8 years (interquartile range, 2.6–5.3). Most batteries were found in the stomach (64%, n = 28), but were also identified in the esophagus (14%, n = 6), small bowel (14%, n = 6), and colon (9%, n = 4). All esophageal batteries were managed with immediate endoscopic retrieval. Ten gastric batteries were not managed per protocol, with seven admitted for observation despite being asymptomatic and repeat abdominal X-rays demonstrating persistent gastric location of the battery. Four patients underwent esophagogastroduodenoscopy; however, in two patients the battery had migrated past the stomach prior to intervention. All small bowel batteries and three of four asymptomatic colon batteries were managed per protocol; one patient had additional imaging that demonstrated battery passage.

Conclusion Adherence to a symptom-focused protocol for conservative management of button battery ingestions beyond the gastroesophageal junction is safe and frequently does not require admission, serial imaging, or intervention.



Publication History

Received: 30 June 2021

Accepted: 21 October 2021

Publication Date:
16 December 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany