Fatal Button Battery Ingestions: 71 Reported Cases

Case #  Year Reported  Author
(or MMWR
case # if
applicable) 		 Age  Sex  Imprint  Diam (mm)  Chemistry  Intended Use  Time to Removal  Battery Location 
 Complications  Signs & Symptoms  Procedures and Treatment 
 1 1977 Blatnik  2.5 y  M  PX 825  23.0 MnO2 movie camera  ≥26 hours  upper esophagus at thoracic inlet massive hematemesis, shock, cardiac arrest 8 days post removal (≥9 days post ingestion); tracheoesophageal fistula; erosion of inferior thyroid arteries and veins; exsanguination into bronchi and lungs  vomiting, fever, lethargy, aphonia, inability to swallow, tender swelling suprasternal notch, tracheal shift, increased WBC endoscopic removal from esophagus; steroids (presumed to have masked progression) 
 2 1979 Shabino  16 mo  F  PX 825  23.0  MnO2 camera flash  ≥4 days  upper esophagus  Perforation of esophagus and right tension hydropneumothorax (~4 days post ingestion); widened mediastinum - drain inserted (~5 d post ingestion); aortoesophageal fistula - perforation of posterior aspect of aortic arch near origin of left subclavian (~5 d post ingestion); massive exsanguination; cardiac arrest   vomiting, fever, irritability, abdominal distention, tachypnea, 10% dehydration, acrocyanosis  tube thoracostomy (~4 days post ingestion); battery removal by esophagoscopy (~4.5 days post ingestion); mediastinal drain and gastrostomy feeding tube inserted (~5 days post ingestion) 
3  1991 Peralta 11 mo  F  unk  15  unk  watch  >30 hours  upper esophagus  extensive bilateral pneumonia, anemia requiring transfusion; tracheoesophageal fistula 3x2.5 cm diameter  fever, cough, vomiting, rejecting food and fluids; respiratory distress; cyanosis; pallor  endoscopic removal 
4 1994 Sigalet 3 y  F  unk  unk  unk  unknown  unknown  upper esophagus 
 aortoesophageal fistula (presumed, no post done); presumed mediastinal abscess (air at impaction site and sepsis)  dysphagia; fever; dehydration; elevated white blood cell count; sepsis; massive bright red bleeding from mouth 5 days post removal  endoscopic removal; granulation tissue seen 
5  2004 Chang YJ  unk  U  unk  unk  unk  unknown  ~2 days
before
death
(not removed) 		 esophagus 
 		 esophageal perforation leading to pneumothorax and pneumoperitoneum; died suddenly in ER  intractable cough; poor appetite  none 
6 2004 BBC
News
and
tele-
graph-
co.uk		 13 mo  M  unk  unk  unk  camera  11 days in
esophagus,
never
diagnosed
or removed

 upper esophagus or hypopharynx with damage to trachea (presumed tracheoesophageal fistula) 
 ulcerated esophagus with tracheoesophageal fistula and bleeding; respiratory failure; death  repeated vomiting, breathing difficulty; wheezing, difficulty drinking and eating, weight loss; misdiagnosed as viral infection  no x-ray done thus diagnosis missed despite hospitalization 
7 2004 NBIH
(MMWR 3) 		 2.5 y  M  CR 2032  20.0  lithium  remote control
of portable
stereo
system
("boombox") 		 ≥10 days
 upper esophagus   aortoesophageal fistula (estimated 10 days post ingestion); massive exsanguination; cardiac arrest  unresponsive, dyspnea, hematemesis, melena  battery removal by rigid esophagoscopy; emergency thoracotomy for massive bleeding uncontrolled by ET and balloon catheters in esophagus; open cardiac massage 
8  2005 Hamilton
& NBIH
(MMWR 4)		 19 mo  M  unk  unk  lithium  garage door opener  1 day  2 batteries ingested: one in stomach, one in mid-esophagus 2 cm aortoesophageal fistula at proximal descending aorta; massive bleeding and death 10 days after battery removal  presented with 1 day of abdominal pain, shallow respirations, lethargy, anorexia, cough; massive bleeding from aortoesophageal fistula 10 days post battery removal  battery removal by esophagogastroscopy; contrast swallow post-op day 4 suggested walled off tract along distal esophagus; child discharged; developed cyanosis and lethargy suddenly at home; CT showed IV contrast in esophagus & stomach; thoractomy - cross-clamped hypovolemic aorta 
9 2008 NBIH &
Morten-
son		 15 mo  M  CR 2032  20.0  lithium electric candle  not removed;
in place 2
weeks 		 esophagus at level of tracheal bifurcation aortoesophageal fistula - child exsanguinated 2 weeks after ingestion; blood in stomach and first part of duodenum on post; erosions in esophagus at level of tracheal bifurcation; fistula a few mm in diameter
 fussy, crying, dark stools with suspected blood; respiratory problems  battery never removed as diagnosis not made until post mortem done 
10 2008 NBIH &
Brum-
baugh 
(MMWR 7); Leinwand (Case 2)		 16 mo  F  CR 2025  20.0  lithium  unknown  suspect
ingested 7-13
days prior to
removal
 		 mid-esophagus; moved spontaneously to stomach esophageal erosions with small amount of blood in paraesophageal and para-aortic tissues; child arrested (from blood loss) in OR and could not be resuscitated
 hematemesis  vomited blood a second time just prior to planned endoscopic removal - exploratory laparotomy done instead; clot and battery evacuated from stomach; clotted blood formed cast of distal esophagus and stomach 
11 2009  NBIH &
Brun-
baugh
(MMWR 9); Leinwand (Case 3)		 2 y  F  CR 2032  20.0  lithium  Yahtzee toy  10 hours  distal esophagus aortoesophageal fistula
 projectile vomiting of blood 18 days after battery removal  endoscopic removal of battery from esophagus 
12 2009  NBIH
(MMWR 8) 		 2.5 y  M  unk  unk  unk  receiver unit
for remote
control
light switch 		 4-5 days  upper esophagus 
 exsanguinated; fistula between esophagus and right subclavian artery
 vomiting only with solid food x 4-5 days; tolerated liquids; otherwise acting normally; hematemesis 4-5 days post ingestion, then into shock  resuscitation; balloon in esophagus to attempt to control bleeding 
13 2009 NBIH
(MMWR 10) 		 13 mo  M  CR 2032  20.0  lithium  unknown  10 days  removed from stomach; suspect lodged in mid esophagus then dropped to stomach aortoesophageal fistula with massive exsanguination 2 days post removal and 12 days post ingestion  coughing; gagging; chest congestion; vomiting; refusal to eat; guaiac positive, tarry stools; massive hematemesis 2 days after battery removal  endoscopic removal of battery from stomach 10 days post ingestion; battery presumed to have moved to stomach from esophagus 
  Fatalities 1 to 13 above were included in the publication:
 Litovitz T, Whitaker N, Clark L, White NC, Marsolek M: Emerging battery ingestion hazard: Clinical implications.  Pediatrics 2010;125(6): 1168-77. epub 24 May 2010.
 Cases below occurred or were identified after compilation of data for this publication.
14 2010  NBIH
(MMWR 14) 		 2 y  F  CR 2025  20.0  lithium  unknown  not removed
(unknown
time of
ingestion) 		 mid-esophagus aortoesophageal fistula 5 cm above gastroesophageal junction
 hematemesis; exsanguinated  orogastric tube placed and battery dislodged to stomach 
15 2010  Soerdjbalie-
Maikoe 		 2 y  F  CR 2032  20.0  lithium  unknown  11 days  mid-esophagus
 aortoesophageal fistula between aberrant right subclavian artery (arteria lusoria) and esophagus; hemothorax, blood throughout gut on post mortem; focal mediastinitis; esophageal perforation and esophagitis  sore throat, high fever, cough, diarrhea, vomiting after every drink or meal, seizure, hypotension, anemia, melena, hematemesis, collapse  thoracotomy 
16 2010  Baeza
Herrera 		 3 y  M  unk  20.0  lithium  remote
control
for video
player 		 1 day  mid-esophagus
 aortoesophageal fistula developed 11 days post ingestion (10 days after removal); liquid diet started on day 6 and child was asymptomatic; sudden hematemesis occurred and child exsanguinated from hemorrhagic shock in the hospital despite attempts to resuscitate; autopsy showed burns throughout esophagus and 3 cm perforation in distal third of esophagus into the thoracic aorta; large amounts of blood were found in the stomach and the cardiac chambers were empty  initial abdominal pain and vomiting; asymptomatic by day 6; hematemesis 11 days post ingestion (10 days post removal) endoscopic removal of battery from esophagus; repeat diagnostic endoscopy on day 10 
17  2011 LaFrance
(MMWR 11) 		 3 y  F  CR 2032  20.0  lithium  unknown  unk, <3 weeks  upper esophagus, at thoracic inlet
 		 hemoptysis, exsanguination and aspiration of blood; tracheoesophageal fistula
 T&A 3 weeks prior to death obscured determination of time of onset of symptoms; 10 days post T&A evaluated for fever and refusal of solid foods; 3 weeks post T&A presented with respiratory distress and vomiting, O2 sat 94% on room air, tachypnea; CXR showed diffuse bilateral infiltrates and coin-like foreign body in esophagus at thoracic inlet; removal scheduled for next day but patient developed coughing spells and marked hemoptysis requiring intubation and transfusion; acute bradycardia and bleeding from mouth, nose, and ET tube followed  intubation, transfusion, unsuccessful resuscitation attempts (stabilized after 30 mins of resuscitation but pupils fixed and dilated, then another episode of massive hematemesis occurred and resuscitation was unsuccessful) 
18 2011  NBIH &
Pae 		 4 y  F  unk  20  lithium   unknown unknown  distal esophagus  aortoesophageal fistula  child vomited blood and collapsed at home; unresponsive with no pulse or breath sounds on arrival in ED; CPR initiated; pH dropped to 6.9; hemoglobin undetectable; regained spontaneous circulation with fluids and blood; no prior symptoms; ingestion not witnessed; apneic and pulseless on arrival at ED   thoracotomy showed aortoesophageal fistula; aorta cross-clamped but child continued to bleed; arrested in OR and could not be resuscitated; battery not removed
19 1998  MMWR 1  16 mo  F  unk  unk  unk  unknown  unk  esophagus exsanguination from arterio-esophageal fistula    unknown unknown 
20 2002  MMWR 2  15 mo  F  CR 2016  20.0  lithium  toy watch?  >24 hours  proximal esophagus  exsanguination from aortoesophageal fistula
 vomiting, melena, hemorrhaging; symptoms developed > 5 hours post ingestion  battery identified on x-ray 19 hours after symptoms developed (>24 hours post ingestion) 
21  2006  MMWR 5   1 y M  unk  unk  alkaline  remote
car alarm 		 ≥4 days
 esophagus  tracheoesophageal fistula; anoxic encephalopathy secondary to TE fistula
fever, decreased appetite, suspected croup  child taken to hospital after 2 days of fever; diagnosed with croup and discharged. Returned 2 days later at which point a radiograph showed a battery in the esophagus. Battery removed but child died 6 days later. 
22 2007  MMWR 6  7 mo  F  unk  unk  unk  unknown  unk  proximal esophagus  acute fistulous erosion of esophageal ulcer into carotid artery  massive hematemesis  battery removed endoscopically 
23  2010  MMWR 12  2 y  F  unk  unk  unk  unknown  ≥5 days
 		 upper thoracic esophagus  esophageal perforation; bleeding  sore throat, dysphagia, choking, dyspnea, tachypnea, dark stools, listless  child treated for strep by pediatrician; taken to ED 5 days later where an x-ray identified foreign body in esophagus. Battery removed in hospital where child died 2 days later. 
24 2010  MMWR 13  2 y  F  CR 20xx  20.0  lithium  unknown  unk  esophagus  esophageal damage, necrosis and hemorrhage; esophageal tear  vomited blood, cardiovascular collapse  Unknown time of ingestion. Child "became ill" and vomited blood. Condition deteriorated after transfer from initial hospital. Died at hospital. 
25 2011  MMWR
footnote 		 13 mo  F unk  20.0  lithium  watch  unk  esophagus  unknown unknown  unknown 
26 2011  MMWR
footnote 		 3 y  M  unk  unk  unk  unknown  unk  esophagus  aortoesophageal fistula hemorrhage  unknown 
27 2012  MMWR
footnote 		 4 y  M  AAA
(initial
report
button
battery) 		 AAA unk  unknown  4 days  mid esophagus  two fistulas: esophagus to aorta and esophagus to pulmonic artery
 initial choking and vomiting; refusal to eat, abdominal pain and fever developed over next day or so; throat pain reported 4 days after swallowing battery; child had multiple pre-existing medical problems (DiGeorge syndrome, right aortic arch with aberrant origin of left subclavian artery, arthritis treated with NSAIDs); 32 days post ingestion he developed nose bleed and hematemesis then arrested and could not be resuscitated due to massive bleeding  battery removed from esophagus by rigid esophagoscopy with the aid of a balloon catheter; child died 32 days post ingestion (28 days post battery removal) 
28  2012  CPSC;
NBIH 		 2 y  F  unk  20  lithium  unknown  ~8 days  esophagus  esophageal-carotid fistula; battery removed from upper esophagus; 3 weeks later child presented with gastric bleeding and seizures; large necrotic mass in neck on MRI and peptic ulcer with blood clot; transfused and placed on ventilator; one day after admission began to vomit blood, went into cardiac arrest and could not be resuscitated  gastric bleeding; seizures; necrotic mass in neck; peptic ulcer with blood clot; hypotension  battery removed from upper esophagus 
29 2012  NBIH  13 mo  M  DL 2032  20.0  lithium  unknown  unk  battery in stomach; bleeding site identified on post mortem  gastric erosions; massive upper GI bleed followed several hours after a sentinel single episode of hematemesis  sentinel episode of hematemesis preceded massive upper GI bleed none 
30 2013  Martinez  23 mo  M  unk  20.0  lithium  unknown  unk  proximal esophagus (thoracic inlet)  esophageal ulceration; aortoesophageal fistula in upper esophagus   odynophagia, sialorrhea, stridor x 2 weeks prior to presentation without improvement with steroids; repeated hematemesis following attempted battery removal; hemorrhagic shock treated with blood and pressors and CPR
 endoscopic removal of battery from esophagus attempted but battery displaced to stomach; unable to cauterize bleeding in esophagus on repeat endoscopy
31 2013  NBIH;
media;
Taghavi 		 4 y  F  unk  20.0  lithium  unknown  ≥2 weeks  mid esophagus
 		 aortoesophageal fistula at aortic arch near origin of left subclavian artery; death from hemorrhage  presented with epistaxis following 2 weeks of abdominal pain and melena; discharged home; vomited a cup of fresh blood at home and brought back to the ER in shock; massive hematemesis and coma followed  intubated; chest x-ray performed to confirm ET tube position showed mid-esophageal battery; transfusions; CPR; thoracotomy showed large, tense mediastinal hematoma 
32 2010  NBIH 735607
(this case is duplicated on Severe Cases list, case 89; child died nearly 2 years and 10 months after ingestion) 		 10 mo  F  unk  20.0  lithium  unknown  >8 hours  cervical esophagus  tracheoesophageal fistula; died (found unresponsive) nearly 2 years and 10 months after the battery ingestion  initial gasping and choking; cyanosis. Stridor developed  tracheostomy required; unknown other procedures 
33 2013  NBIH  16 mo  M CR 2025 20.0  lithium  unknown  ~7 days  proximal esophagus  massive upper GI bleed of undetermined origin; possible concomitant acetaminophen toxicity (used to treat child prior to removal); child died approximately 3 days after removal; there was evidence of pulmonary edema, pneumonia, uncontrollable esophageal bleeding and mediastinitis in addition to renal and liver failure  presented initially with cough and congestion; later developed profoundly elevated INR, PTT, AST, ALT; Hct dropped to 17; hypotensive with hematemesis, melena, and acidosis exploratory lap done to decompress abdomen due to massive bleeding with prolonged intraoperative arrest; bright red blood in lower esophagus and stomach 
34 2013  NBIH  23 mo  M unk unk  unk  camera  unk  esophagus  GI bleed, laceration of the  esophagus, collapsed lung, gastric irritation   hematemesis unknown 
35 2014  Takesaki  5 y  M unk ~20   lithium  unknown  ~10 days or
more 		 injury in distal esophagus; battery passed   to lower colon spontaneously deep ulceration of lower esophagus; presume esophageal-vascular fistula but not confirmed; massive hematemesis; profound hypotension; two cardiopulmonary arrests  abdominal pain x 10 days followed by hematemesis, pallor, tachycardia (150 beats/min), hypotension (60 mm Hg), and Hct 27%  UGI endoscopy demonstrated deep ulcerated lesion in distal esophagus; additional profuse hematemesis followed the endoscopy accompanied by severe hypotension; Sengstaken-Blakemore tube inserted; cardiopulmonary arrest followed, resuscitated with CPR and epinephrine; subsequent exploratory laparotomy showed a large amount of blood in the stomach; child arrested again and could not be resuscitated; battery removed manually per rectum 
36 2014  Hama-
wandi 		 28 mo  M unk unk  unk  unknown  ≥5 days  esophagus  esophageal perforation; child died at home on 7th day (family refused surgery and discharged child)  unknown family refused treatment 
37 2013  Connor L
(News) 		 1 y  F unk  unk  unk  torch  ~1 day  esophagus   aortoesophageal fistula  massive bleeding  battery removed from esophagus; child discharged from hospital; returned 8 days post ingestion (6 days after removal) with massive bleeding; heart abnormality detected on post mortem 
38 2014  News  4 y F  unk  20 (suspected due to
coin-like
description) 		 lithium
(suspected due to
coin-like
description)
 unknown  unk  esophagus   massive upper GI bleed, presumed to be an esophageal-vascular fistula
 		 presented with difficulty breathing; hematemesis developed about 7 days later
 battery removed; child died about 7 days post removal; massive hematemesis developed when NG tube was removed
39 2014  Mercer RW  4 y  M  CR 2032  20  lithium  unknown  ≥2 days  upper esophagus, at level of aortic arch child with trisomy 21, diagnosed with a vascular ring at the time of button battery ingestion; died 9 days after presentation due to massive upper GI bleeding from a vasculoesophageal fistula; patient found unresponsive in hospital room; during intubation, massive amounts of bright red blood emerged from esophagus; hypotension and acidosis followed; resuscitation unsuccessful; post mortem showed a necrotic transmural ulceration of the esophagus; blood found in stomach and small intestine; the vascular ring caused esophageal narrowing due to external compression   presented with 2 days fever, difficulty breathing and decreased oral intake; no known cardiovascular history but reported longstanding intolerance of solid foods with frequent vomiting  endoscopic removal revealed extensive avascularity, blanching and necrosis on posterior, left lateral and anterior esophageal walls; obstructed esophageal lumen; microlaryngoscopy and bronchoscopy showed no tracheal involvement; post-op CT angio showed right aortic arch with an aberrant left subclavian artery originating from a Kommerell diverticulum consistent with a vascular ring; Kommerell diverticulum adjacent to a contained esophageal perforation (3.3x2.9 cm air fluid collection); repeated flexible and rigid endoscopy with NG tube placement and bronchoscopy 2 days post removal 
40 2014  Times
Live 		 2 y  F unk  unk  unk  unknown  ~2 weeks  esophageal-vascular fistula (unspecified artery involved)  massive upper GI bleed, presumed to be an esophageal-vascular fistula  sore throat and chest over 2 weeks; began vomiting blood Oct 19, 2014; rushed to hospital; died hours later   unknown
41 2014  BBC News  3 y  F  unk  unk  unk  unknown  unk  unk  unknown  severe hemorrhage  unknown 
42 2015  Barabino  22 mo  F  CR 2032  20  lithium  unknown  unk  mid esophagus aortoesophageal fistula due to lithium battery lodged in mid esophagus (found on autopsy) bloody emesis occurred once an hour prior to admission; slight pallor, mild tachycardia and Hgb 7.7 g/dL  on presentation; Hgb dropped to 6.2 g/dL 5 hours later without evidence of ongoing bleeding; almost 8 hour after presentation, sudden severe hematemesis occurred followed by cardiorespiratory arrest; resuscitation attempted over 2.5 hours but upper GI hemorrhage was uncontrollable  resuscitation attempted (transfusion, ventilation, cardiac massage); battery not removed prior to death 
 43  2015 Chow; Mannix  14 mo  F  CR 2025  20.0  lithium  unknown  2-3 weeks  distal esophagus  aortoesophageal fistula due to lithium battery lodged in the esophagus  2 to 3 weeks of nonspecific symptoms (vomiting, lethargy, refusal of food and fluids, fever, abdominal pain, difficulty settling, dark green stool) diagnosed as urinary tract infection, including 3 ED presentations; acute onset hematemesis with large clots was followed by cardiac arrest; resuscitation was successful but further hematemesis resulted in a second cardiac arrest and she could not be resuscitated battery not removed prior to death
 44 2015  NBIH  17 mo  F  unk  20.0  lithium  unknown  not removed prior to death   mid esophagus death due to exsanguination from fistula from esophagus to aberrant right subclavian artery  exsanguinated on arrival to emergency department; presented with hematemesis and hemoptysis; sentinel bleed: melena 7 days prior to presentation; unrelenting hematemsis progressed to cardiac arrest  crash thoracotomy; unsuccessful attempt to repair injury 
45  2015  Sarkar  3 mo  M  unk  20.0  lithium  unknown  ~ 36 hours  upper esophagus (C5-6 level)  large tracheoesophageal fistula; severe ARDS with pulmonary hemorrhage leading to death ~ 10 days post ingestion and 5 days post TE fistula repair  refusal to suck; excessive crying and drooling; tachypnea; severe respiratory distress developed 4-5 days after removal with hyperextension of the neck endoscopic battery removal; thoracotomy to repair TE fistula; esophagostomy; feeding jejunostomy; mechanical ventilation
46  2015  Stogsdill; NBIH  2 y  F  CR 2032  20.0  lithium  tea light (loose spare)  ≥4 days
  esophagus massive hemorrhage; esophageal-vascular fistula fever and vomiting for about 4 days prior to presentation; massive hematemsis; cyanosis surgical attempt to control bleeding and resuscitate child 
47  2016 Guinet  17 mo  F CR 2032  20.0 lithium  unknown  not removed prior to death  upper esophagus  esophageal ruptures (lengthwise at right posterior esophageal wall and at the left anterior esophageal wall in contact with left carotid artery but not completely perforated); large amount of blood aspirated into bronchi; coma; prehospital cardiac arrest; postmortem tox analysis showed heavy metals in elevated but nontoxic concentrations  hematemesis; coma; cardiorespiratory arrest; ER evaluation for bronchitis and nasopharyngitis 18 and 14 days prior to death  prehospital arrest; CPR unsuccessful 
48  2015  Zarei  3 mo  F  unk  unk  unk  unknown  ~2 days  proximal esophagus  tracheoesophageal fistula  2 days of vomiting, cough, intolerance of milk, and agitation; cough, dyspnea and cyanosis developed 12 hours post removal  laryngoscopic removal of battery from esophagus; tracheoesophageal fistula repair; child died in hospital 3 days later 
49 2016  Rockett (Mirror News); Crouch (The Sun)
  2 y  F unk  20.0  lithium  3D TV glasses  not removed prior to death  esophagus  massive hemorrhage; esophageal battery eroded into subclavian artery "very sick"; died within a couple hours of hospital presentation; had been symptomatic for ~8 days but diagnosis was missed  unknown
50 2015 CPSC  18 mo  M  unk   25 lithium  unknown  ~9 days  esophagus  esophageal perforation; hemorrhage  vomiting; fever, dyspnea, blood per rectum 11 days post-removal  endoscopic removal of battery from the esophagus; feeding gastrostomy; blood transfusion; surgical repair of esophageal perforation
51  2017  NBIH  2 y  F  CR 2032  20.0  lithium  unknown
 		 24-36 hours  espophagus  hematemesis pre- and post-endoscopy; child died of massive bleed about 10 hours after presenting to ER with hematemesis; esophageal erosions  presented to ER with hematemesis. Xray showed battery in exophagus  endoscopic removal of battery 1-2 hours after initial x-ray. Unable to remove battery so it was pushed into stomach and not removed prior to death.
52  2016  Nisse  4 y  F  CR 16??  16  lithium  key fob  3 days  mid-esophagus  aortoesophageal fistula; ulceration and necrosis noted at left posterior esophagus during removal; massive exsanguination began on the 6th hospital day, with hemodynamic collapse, two seizures and bradydysrhythmias  abdominal pain; refusal to eat solid foods; drooling; fever; subcutaneous emphysema  battery removal by rigid endoscopy under general anesthesia; oral feeding was resumed on the 6th hospital day; surgical attempts to repair the fistula showed extension of the battery injury into the postero-inferior aspect of the aortic arch and a fistula between the origin of the  left carotid and the esophagus. The child died despite surgery. 
53  2016  NBIH  12 mo  M  CR 2032  20.0  lithium  remote control for sound bar (home theater)  5.5 - 6 hours  upper esophagus  perforation of esophagus into mediastinum; tracheoesophageal fistula diagnosed 17 days post ingestion; healing; child doing well and TEF closing spontaneously; respiratory failure developed relatively suddenly 80 days after battery removal vomiting prior to removal  battery removed under laryngoscopic view 
54  2016  Bhosale  2 mo  M  unk  10  unk  toy  ~5 days  upper esophagus  large tracheoesophageal fistula just below cricopharynx diagnosed on esophagoscopy 8 days after battery removal; mediastinitis; sepsis; bile reflux developed and child succumbed to sepsis 15 days after battery removal  fever, respiratory distress, irritability x 5 days  battery removal from esophagus by rigid esophagoscopy; unable to place infant feeding tube; intubated and on ventilator x 3 days; reintubated 10 days after battery removal due to abdominal distension and respiratory compromise. Deflating gastrostomy and feeding jejunostomy were done 
55 2016 Ventura  18 mo  F  CR 2032  20.0  lithium  unknown  not removed prior to death; unknown time of ingestion mid esophagus  aortoesophageal fistula with massive amounts of blood in the bronchi, stomach and small bowel; deep ulceration in esophagus  vomiting blood; severe anemia (Hgb 6.2g/dL); tachycardia; loss of consciousness intensive resuscitation efforts were unsuccessful 
56  2017  Boba  1 y  M  unk  20.0  lithium unknown  >2 hours  proximal esophagus  local necrosis and edema; esophagitis, mediastinitis and microperforation; septic shock with multiple-organ failure, acidosis, clotting disturbances and acute anemia  sialorrhea on presentation; condition worsened on day 3 with sudden onset of tachypnea, tachycardia and fever  removal by rigid esophagoscopy; antibiotics; parenteral nutrition; blood transfusions; bicarbonate 
 57 2017  Safi  2 mo  M  unk  ≥20 mm  lithium  battery fed to child by older brother   24-36 hours (spontaneous passage); in esophagus <3 hours, then passed to stomach cervical esophagus  ulcerative esophagitis of cervical esophagus; esophageal stenosis; death  esophageal stenosis noted on day 8 with respiratory distress and abdominal bloating requiring intubation; pneumonitis; patient died on day 8-9 battery in stomach on initial xray ≥
3 hours post ingestion 
58  2017  Kroll  22 mo  M  CR 2032  20.0  lithium  unknown  not removed prior to death  distal esophagus  aortoesophageal fistula with massive bleeding; large volume of fresh blood in stomach and blood found in airways; on post mortem, battery was incarcerated in ulcerated granulation tissue  Child hospitalized for 3 days for gastroenteritis and dehydration, then discharged. Two days later experienced sudden onset hematemesis; retrosternal pain; difficulty breathing; cough followed by sudden onset hematemesis, rapid loss of consciousness and cardiac arrest  Cardiopulmonary resuscitation unsuccessful; battery was not removed prior to death
 On July 1, 2018 the National Capital Poison Center stopped operating the National Battery Ingestion Hotline. This list does not include cases reported to the National Battery Ingestion Hotline after that date.
59  2018  CPSC (NBIH)  22 mo   F  CR 2032  20.0 lithium  unknown   unknown distal esophagus  button battery embedded in esophagus; ulceration and bleeding noted; stomach full of blood clots; cardiac arrest and died 7 hours after presenting to ED; erosion and ulceration over an 3.6 x 3.0 cm area 1.8 cm above GE junction; aortoesophageal fistula noted on autopsy with pinpoint communication; defect in aortic intima and wall 0.4 x 1 cm  child with no known battery ingestion was evaluated in an ER for an ear infection, cough and cold and sent home. Nine days later she developed bleeding from her nose, then became lethargic and unresponsive; taken to OR to remove battery; cardiac arrest in OR; could not be resuscitated; time of battery ingestion unknown  battery removal from distal esophagus with rigid endoscopy
60  2019  Periasamy  1 y unk  unk  20.0  lithium  TV remote control  10 days  criocopharynx  esophageal edema and erosion 16 cm from incisor. Seizures, massive bleeding from nose, mouth and rectum. Hypovolemic shock, cardiac arrest, death. Suspected aortoesophageal fistula  poor appetite, vomiting during the first 10 days post-ingestion. Esophageal edema and erosion. Seizures, massive bleeding from nose, mouth and rectum. Hypovolemic shock, cardiac arrest, death battery removal from esophagus with rigid endoscopy; CPR 
61 2019  Janarthanan  9 d  M  unk  11.4  unk  toy phone  7 days  criocopharynx  death 32 days after presentation to the ED. Tracheoesophageal fistula, pneumonia, and acute tubular necrosis of the kidneys noted on autopsy. Posterior esophageal necrosis 3.5 x 2.5 cm area; anterior esophageal necrosis 2.5 x 1.5 cm area  fever, nasal discharge, poor feeding, lethargy and noisy breathing for 7 days battery removal from esophagus by endoscopy
62  2019  NCPC  2 y  F  unk  unk  unk  unknown  unknown  esophagus  exsanguination 1 day after battery removal from esophagus  strep throat infection, dyspnea endoscopic battery removal from esophagus 
63  2020  NCPC  3 y  F unk  20.0  lithium  unknown  unknown  esophagus  coma, hematemesis, exsanguination, volume depletion, aortoesophageal fistula, multiple cardio-pulmonary arrests, death epistaxis, fever, inability to swallow solids surgical repair of aorta 
64  2020 Karnecki  15 mo  F  CR 2025  20.0  lithium  unknown  not removed prior to death  esophagus  loss of consciousness, exsanguination,  aortoesophageal fistula, cardiopulmonary arrest, death epistaxis  cardiopulmonary resuscitation unsuccessful; battery was not removed prior to death
65 2020  Duan et. al.  19 mo  M  CR 2025  20.0  lithium  unknown  12 hours  esophagus  fever, hematemesis, dyspnea, tracheoesophageal fistula, bilateral vocal cord paralysis; multi organ failure fever endoscopic removal of battery, tracheotomy 
66  2021  Kennedy News & Media  23 mo  M  CR 2032  20 lithium remote control key finder  not removed prior to death  intestine (post mortem)  hematemesis, cyanosis, loss of consciousness, posturing, respiratory arrest, asystole, aortoesophageal fistula  epistaxis, hematemesis, coughing, vomiting, lethargy, fever  cardiopulmonary resuscitation unsuccessful; battery was not removed prior to death 
67  2020  New York Post  17 mo  F  unk  unk  unknown  remote control  several days  esophagus  tracheoesophageal fistula, cardio-pulmonary distress  wheezing, congestion, lethargy  endoscopic removal of battery; feeding tube placement; surgical repair of fistula; tracheostomy; ventilator support; CPR performed twice 
68 2021  New York Post  2 y   F unk  unk  unknown  remote control  unknown  esophagus  esophageal burn into a major artery; arrhythmia  hematemesis, wheezing  blood transfusion, surgery 
69  2022  Taylor, C; The Sun  1 y  M  unk  unk  unknown  toy monkey  12 hours  heart  hemorrhage, asystole, respiratory arrest, burn through the esophagus and battery embedded in the heart; liver and kidney failure, collapsed lungs  collapsed  cardiopulmonary resuscitation, surgery, oxygen 
70  2019  Puttaiah, et. al.  2 y  M  unk  >=20   lithium  unknown  25 days  esophagus  Cardiomegaly, hepatomegaly, esophago-pericardial and esophago-pleural fistula, pyopericardium, pyothorax,  cardiovascular instability, sepsis, refractory shock Vomiting for 25 days, fever, tachypnea, dysphagia, drooling, intercostal retractions Endoscopic removal of the battery, intravenous fluids, intravenous antibiotics, fluid drainage from heart and lungs, vasopressors
71  2022  Peng, et. al.  18 mo  M  unk  20 mm  lithium   unknown 3 days  esophagus  Mucosal edema and eschar in esophagus; massive hematemesis, shock, acure respiratory and circulartoy failure, multi-organ hypoxia ischemia Fever, dysphagia for 3 days Endoscopic removal of the battery, blood transfusion, fluid resuscitation

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