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Retained metal fragments following esophageal button battery impaction

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Abstract

Button battery (BB) impaction in the esophagus requires immediate endoscopic removal and meticulous follow-up, including serial cross-sectional imaging, preferably with magnetic resonance imaging (MRI). However, BBs quickly degrade in the esophagus, and metallic fragments may remain in the injured mucosa following removal. This metallic debris can cause thermal injury during MRI, potentially aggravating local injury. We aimed to explore whether such metallic fragments could be identified on imaging following BB removal. In this study, we conducted a retrospective review of children (0–18 years) presenting with BB impaction in the esophagus between 2014 and 2020. Endoscopy reports and imaging studies were blindly reviewed by a pediatric gastroenterologist and a pediatric radiologist. Of 161 cases of battery ingestion, 14 (8%) underwent endoscopy, and in 9 (5%) a BB was impacted in the esophagus. The median time from ingestion to BB removal was 8 h (range 2–48 h). The median time from removal to CT was 44 h (range 0.5–104 h). BB appearance ranged from mild corrosion to visible debris. Pre-removal plain films showed irregular battery contour suggesting corrosion (5/7 plain films). In 7/9 CT scans (78%), high-attenuation esophageal content (median 266HU (range 140–1151)), which may represent metallic debris, was identified. Five patients had a follow-up CT which still showed gradual resolution of the high-attenuation content.

Conclusions: we describe a new finding on CT following BB removal which might represent metallic debris. Clinicians should be aware of these findings which potentially may be harmful during MRI used in the ongoing assessment of esophageal injury.

What is Known:

• Button batteries are a dangerous pediatric foreign body with potentially fatal vascular complications.

What is New:

• Metallic debris was identified on computerized tomography following button battery removal in most children.

• We bring to attention this new finding which may affect clinical management, as minimal metallic content can cause burns during MRI.

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Availability of data and materials

Data will be kept at the corresponding author’s facility and will be available upon request.

Abbreviations

BB:

Button batteries

CT:

Computerized tomography

HU:

Hounsfield units

MRI:

Magnetic resonance imaging

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Author notes

  1. Dotan Yogev, Raffi Lev-Tzion are contributed equally to this work.

Authors and Affiliations

  1. Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel

    Dotan Yogev MD, Raffi Lev-Tzion MD, Oren Ledder MD & Esther Orlanski-Meyer MD

  2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Dotan Yogev MD, Oren Ledder MD & Ruth Cytter-Kuint MD

  3. Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel

    Elena Zharkov MD & Ruth Cytter-Kuint MD

Authors
  1. Dotan Yogev MD
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  2. Raffi Lev-Tzion MD
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  3. Oren Ledder MD
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  4. Esther Orlanski-Meyer MD
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  5. Elena Zharkov MD
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  6. Ruth Cytter-Kuint MD
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Contributions

Dr Yogev and Dr Cytter-Kuint conceptualized and designed the study, collected the data, performed the data analysis, reviewed the literature, and drafted and revised the manuscript, Dr Lev-Tzion contributed to the study design and interpretation and analysis of data and revised the initial draft and final manuscript, Dr Ledder, Dr Orlanski-Meyer, and Dr Zharkov contributed to the study design, acquisition of data, interpretation of the results, and revision of the manuscript. All the authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ruth Cytter-Kuint MD.

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Ethics approval

The study was approved by the institutional IRB committee.

Conflict of interest

The authors declare no competing interests.

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Communicated by Peter de Winter

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Yogev, D., Lev-Tzion, R., Ledder, O. et al. Retained metal fragments following esophageal button battery impaction. Eur J Pediatr 181, 143–147 (2022). https://doi.org/10.1007/s00431-021-04184-y

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  • DOI: https://doi.org/10.1007/s00431-021-04184-y

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