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Management of Button Battery–induced Hemorrhage in Children

Brumbaugh, David E*; Colson, Steven B*; Sandoval, John A; Karrer, Frederick M; Bealer, John F; Litovitz, Toby; Kramer, Robert E*

Journal of Pediatric Gastroenterology & Nutrition: May 2011 - Volume 52 - Issue 5 - p 585–589
doi: 10.1097/MPG.0b013e3181f98916
Original Articles: Gastroenterology

Objectives: Button battery ingestions are potentially life threatening for children. Catastrophic and fatal injuries can occur when the battery becomes lodged in the esophagus, where battery-induced injury can extend beyond the esophagus to the trachea or aorta. Increased production of larger, more powerful button batteries has coincided with more frequent reporting of fatal hemorrhage secondary to esophageal battery impaction, but no recommendations exist for the management of button battery–induced hemorrhage in children.

Materials and Methods: We reviewed all of the reported pediatric fatalities due to button battery–associated hemorrhage. Our institution engaged subspecialists from a wide range of disciplines to develop an institutional plan for the management of complicated button battery ingestions.

Results: Ten fatal cases of button battery–associated hemorrhage were identified. Seven of the 10 cases have occurred since 2004. Seventy percent of cases presented with a sentinel bleeding event. Fatal hemorrhage can occur up to 18 days after endoscopic removal of the battery. Guidelines for the management of button battery–associated hemorrhage were developed.

Conclusions: Pediatric care facilities must be prepared to act quickly and concertedly in the case of button battery–associated esophageal hemorrhage, which is most likely to present as a “sentinel bleed” in a toddler.

*Department of Pediatrics, Section on Pediatric Gastroenterology, Hepatology, and Nutrition, USA

Department of Surgery, Division of Pediatric Surgery, University of Colorado Denver School of Medicine, and the Children's Hospital, Aurora, Colorado, USA

National Capital Poison Center, Washington, DC, USA.

Received 23 July, 2010

Accepted 26 August, 2010

Address correspondence and reprint requests to David Brumbaugh, MD, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, B290, Aurora, CO 80045 (e-mail:

Dr Litovitz directs the National Capital Poison Center's National Battery Ingestion Hotline, which is funded in part by the National Electrical Manufacturers Association. The other authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN