Peer Reviewed

Radiology Quiz

What Did This 5-Year-Old Girl Ingest?

David S. Bullard, MD, MEd

Volume 63 - Issue 6 - June 2023

  • Answer: B. Button battery in the stomach.

    Note the “double ring” or “halo” sign suggesting the object is a battery and not a coin. This battery measures 23 mm in diameter. The battery is below the level of the diaphragm, and therefore, in the stomach.

    Discussion. From 1997-2010, more than 40,000 children were treated in hospital EDs for battery-related injuries. There was a 2.5-fold increase in cases during this timeframe.1 This increase is linked to two market changes: increased battery size (³ 20 mm diameter) and augmented lithium battery voltage (3 volts), features associated with more serious outcomes.2,3

    Although rare, significant gastric injury secondary to button battery ingestion has been reported.4 Most data shows that post-esophageal batteries are not associated with major injury, and may be treated with serial radiographs followed by nonurgent endoscopy. More recent guidelines, however, recommend endoscopic intervention in cases of asymptomatic post-esophageal button battery ingestion for patients < 5 years or batteries  ³ 20 mm diameter.1

    Patient outcome. After discussion with gastroenterology, the child was admitted for overnight observation. A repeat abdominal film 8 hours later showed no change in the foreign body location, and the patient underwent endoscopic retrieval (Figure 2). No mucosal damage was noted 24 hours after ingestion.

    Figure 2. Endoscopy image

     

    References:

    1. Centers for Disease Control and Prevention (CDC). Injuries from batteries among children aged <13 years – United States, 1995-2010. Morbidity and Mortality Weekly Report. 2012;61(34):661-6.
    2. Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. Journal of Pediatric Gastroenterology and Nutrition. 2015;60(4):562-74.
    3. Litovitz T, Schmitz BF. Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics. 1992;89(4):747-57.
    4. Honda S, Shinkai M, Usui Y, Hirata Y, Kitagawa N, Take H, Ohhama Y. Severe gastric damage caused by button battery ingestion in a 3-month-old infant. Journal of Pediatric Surgery. 2010;45(9):e23-6.