Advice for medical sector on making the right
diagnosis and offering the right treatment
How to make the right diagnosis?
The ingestion of button batteries/coin cells can be misdiagnosed for a variety of reasons, including:
- The ingestion, particularly by young children, is not always witnessed.
- Battery ingestion has non-specific symptoms and symptoms of lithium coin cell ingestion can resemble flu-like symptoms.
- Ingested button batteries/coin cells can be mistaken for coins.
Ingested button batteries can be very dangerous when they stay lodged in the esophagus and require urgent medical attention. The risk is particularly high for lithium-containing coin cells due to their higher voltage. The greater diameter adds to the hazard, as the larger diameter cell is more likely to get stuck in the esophagus.
If the treating physician is not sure what type of battery has been ingested, the treatment should be based on the worst case scenario assumption that a lithium coin cell battery has been ingested.
The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Task Force for button battery ingestions developed a medical algorithm to help the medical sector in diagnosing and treating ingestion cases – read full paper here or download the medical algorithm
In most witnessed ingestions, patients experience acute gastrointestinal or respiratory symptoms such as vomiting, drooling, dysphagia, odynophagia, irritability, coughing, stridor and shortness of breath
In unwitnessed ingestions, patients usually present themselves to the hospital when complications have already occurred, which can take from a couple of hours to days and even weeks. They usually experience hematemesis or hemoptysis, melena, abdominal pain, weight loss, chest pain, cough, stridor, hoarseness, sore throat, decreased range of motion of the neck, and fever. Acute haemorrhage has also been observed.
Two-view (anterior-posterior and lateral) X-ray is paramount to diagnose ingestion and confirm its location. It is important that the X-ray includes the entire neck, chest and abdomen to avoid missing the button battery. In addition, close inspection of the image is necessary to identify a double ring or halo sign, which can distinguish a battery from a coin, and to determine the position of the negative side of the battery, which is the step-off side on the lateral film.
Treatment options depend on two critical factors: whether the battery is still in the esophagus or if it’s already beyond the esophagus. Equally important is the time of the suspected ingestion, ie, if it took place within the past 12 hours or if more than 12 hours have already past. When the battery is located in the esophagus immediate endoscopic removal is necessary, if possible within 2 hours of ingestion.
ESPGHAN’s algorithm for treating cases of button battery ingestion include a step-based treatment depending on the conditions of the patient and the assumed time of ingestion – download algorithm here.
