Nonfatal Button Battery Ingestions with Severe Esophageal or Airway Injury: 178 Cases

Case #  Year Author  Age Sex Imprint Diam
Chemistry Intended
Time to Removal Battery
Complications Signs and Symptoms  Procedures and Treatment Days to Normal Feeding
 1  1982 cited in
2 pubs:
25 mo M EPX 825 23 MnO2 camera  5 days upper esophagus 5 mm tracheoesophageal fistula enlarged to 3 cm later; cardiac arrest secondary to anoxia cyanosis, tachypnea, dysphagia endoscopic battery removal; gastrostomy; thoracotomy; esophagostomy; lower esophagus ligated; discharged ~28 days post ingestion; colon interposition performed about 7 months post ingestion >7 mo
 2  1983 Litovitz
16 mo U EPX 825 23.0 MnO2 unknown 6 hours upper esophagus (cricopharyngeus)
esophageal perforation with spontaneous closure within 6 weeks
symptomatic but specific symptoms not described  steroids; antibiotics  unk
 3  1984 cited in
3 pubs:
10 mo F EPX 13 15.6 mercuric oxide camera ~18-22
upper thoracic esophagus
tracheoesophageal fistula 4 weeks post ingestion; stricture at burn site; fistula closed spontaneously; RLL pneumonia; pseudomonas septicemia; tracheomalacia 
18-22 hours of irritability and dysphagia; refused food; fever; copious black saliva removal by esophagoscopy 18-22 hours post ingestion; severe circumferential burn with charred material, worse anteriorly; home on NG tube feedings after 3 weeks; gastrostomy 15 weeks post injury; dilatation failed so attempted retrograde dilatation via gastrostomy; 8 months post ingestion esophagectomy required; tracheomalacia with ventilatory insufficiency requiring tracheotomy; decannulated and eating >2 years post burn > 2 yrs 
 4  1984 McNicholas 3 y M unk unk alkaline camera ~3 weeks upper esophagus 4 cm posterior esophageal wall inflamed; tracheoesophageal fistula (.5 cm wide, 2 cm long) 4 cm above carina
chest infection unresponsive to antibiotics; drooling, refusal to swallow, coughing with swallowing post removal removal by esophagoscopy; gastrostomy; 7 weeks post ingestion surgical closure of TE fistula; mild narrowing of esophagus post op requiring 2 dilations  ~2 mo
1986  Van
9 mo F unk 16 mercuric oxide camera ~8 days upper esophagus (T1) large tracheoesophageal fistula 1.5 cm below vocal cords; necrosis and edema of esophageal wall at impaction site; esophageal stricture; septicemia coryza x 1 week; 2 days croupy cough, respiratory distress, intolerance of solid food; melena; respiratory difficulty and tachypnea; fever removal by rigid esophagoscopy; gastrostomy for feeding; parenteral alimentation; weekly dilations of esophagus for esophageal stenosis; in hospital > 2 months; home on tube feedings until fistula resolved 5 months after initial injury but stricture persisted > 5 mo 
6 1987  Kost 18 mo M unk 20 lithium unknown 29 days upper esophagus esophageal burn and stricture involving a 5 cm segment of upper esophagus
drooling, vomiting, irritable, refusing solids and liquids, otitis media; brought to ED or clinic 6 times over a month with fever, decreased oral intake, vomiting, cough, rhinorrhea, noisy breathing endoscopic removal from esophagus; 7 months of frequent esophageal dilations, progressing to less frequent dilations > 7 mo 
1987  Rivera
& Maves 
3 y  PX 825  23.0  MnO2
unknown  ~48 hours  upper esophagus  circumferential burn of cervical esophagus at cricopharyngeus; perforated esophagus with free air in soft tissues of neck; esophageal stricture  pain and dysphagia  removal by esophagoscopy; recurrent dilations required for > 2 years  > 2 yr
1988  Sigalet  4 mo  M 76  11.6  unk  camera  ~30 hours  upper esophagus; negative pole anterior  battery mistaken for cardiac lead or thermistor probe on x-ray; not diagnosed until nasogastric tube passage failed; 3 cm esophageal burn starting 2 cm below cricopharyngeus; 2-3 mm tracheoesophageal fistula developed on 3rd post op day, later 5 mm in size; tracheomalacia; difficulty feeding until 1 year of age  severe respiratory distress; difficulty feeding; tachypnea; fever  removal by rigid esophagoscopy; conservative management attempted with decompressing gastrostomy and feeding jejunostomy; fever and increased tracheal secretions occurred; 6th hosp day diverting cervical esophagostomy; 3 months later resected retrotracheal portion of esophagus and reconstructed esophagus using colon interposition   
1989  Vaishnav 16 mo  unk  20
(originally reported
as 10 mm
but parent
reinterview-ed by author) 
MnO2  watch  ~4 weeks  upper esophagus at thoracic inlet  large tracheoesophageal fistula (1 cm diameter fistula) which recurred twice after repair  dysphagia x 4 weeks prior to removal; feeding problems continued after removal   endoscopic removal; nasogastric tube feeding; surgical repair ~ 7 weeks post ingestion; fistula recurred 6 weeks later; 3 mm diameter TE fistula repaired again; 2nd recurrence required resection of 3 cm length of esophagus surrounding fistula and end-to-end anastomosis with omohyoid muscle mobilized between trachea and esophagus   
10  1990  NBIH  2 y  unk  unk  unk  unknown  >48 hrs  esophagus (mid)  suspected tracheoesophageal fistula (based on tx provided)  initial dx: croup endoscopic removal; tracheostomy; esophageal resection  > 1 mo 
11 1990  NBIH  child  386 A  11.6  MnO2  walkman  9 days  esophagus  diagnosis missed on 3 x-rays & 7 ER visits over 9 days; unknown specific injury that required esophageal resection  persistent vomiting  esophageal resection and anastomosis  unk 
12  1992  Litovitz  10 mo  BR 2016  20.0  lithium  watch  9.5 hours  upper esophagus  1 cm2 burn in esophagus; scar tissue in larynx; esophageal stenosis in cricopharyngeal area  irritable; refused solid food; progressive dysphagia  removal by laryngoscopy; repeated esophageal dilation required over 5 years  ~ 5 yr 
13  1993  Gordon  18 mo  unk  unk  unk  hair dryer  3 days  upper esophagus  esophageal perforation (blind pouch posterior to esophagus); stricture developed at 7 weeks requiring resection with primary anastomosis; 3 subsequent esophageal dilations required  dysphagia x 3d prior to removal  removal by esophagoscopy  > 2 mo
< 2 yr 
14  1993  NBIH  11 mo  CR 2025  20.0  lithium  handheld computer game  6.75 hours  distal esophagus  esophageal perforation 12 hours post ingestion; tension pneumothorax; empyema (tx'd then recurred); pulmonary abscess
vomiting  endoscopic removal; attempted to push battery into stomach unsuccessfully; chest tube; decortication of lung to tx empyema; hospitalized 35 days, discharged, returned to ER for drainage of another large empyema; tube feedings x 3-4 mos  >3-4
15  1993  NBIH  8 y  unk  unk  unk  watch  1 day  left mainstem bronchus  left lower lung collapsed; circumferential burn to bronchus  pleuritic chest pain  removal by rigid bronchoscopy  unk 
16  1994  NBIH  18 mo  CR 2016  20  lithium  calculator  ~4 days  esophagus (mid)  esophageal perforation; tracheoesophageal fistula; esophageal stricture still present 3 years post ingestion  fever, sore throat, difficulty swallowing  endoscopic removal from esophagus; surgical repair for TE fistula  > 3 yr 
17  1996  Senthilkumaran  5 mo  unk  ~ 22  unk  toy  12 days  upper esophagus (T2)  tracheoesophageal fistula at T2-T3   difficulty breathing, fever, choking; hospitalized x 10 days for recurring chest infection prior to diagnosis; cough associated with drinking persisted after battery removal   removal by esophagoscopy; patient NPO after TE fistula detected and fed parenterally x 3 weeks then by nasojejunostomy; TE fistula healed 6 weeks after battery removal (about 8 weeks post ingestion)  > 8 wk 
18  1996  NBIH 13 mo  unk  20  lithium  camera  ≤2.5 hours  upper esophagus (cricoid)  mild subglottic edema; stridor persisted > 1 month; all symptoms resolved by 6 months  coughed, choked, vomited immediately after ingestion  laryngoscopy/bronchoscopy; tracheostomy tube x 6 weeks for persistent stridor   
19  1997  Wall  13 mo  unk  unk  unk  unknown  3 hours  esophageal inlet  circumferential burns of esophagus at cricopharyngeus; desaturation; respiratory compromise  stridor   tracheotomy 29 days post ingestion, extubation tolerated 75 days post ingestion without respiratory sequelae or esophageal dysmotility  > 75
20  1997  NBIH  3 y  PX 825  23  MnO2   unknown  >3 days  cervical esophagus  severe burns in esophagus and trachea  inability to swallow; evaluated by physician and presumed viral illness  cervical esophagostomy; gastrostomy placement unknown 
21  1997  NBIH  11 mo  CR 2016  20.0  lithium  unknown  >24 hours  upper esophagus  circumferential burns of esophagus; esophageal stenosis  drooling; refused to eat or drink  stent placed in esophagus for 3 weeks; dilatation x 2  > 5 wk
22  1997  NBIH  8 mo  unk  >21 mm  lithium calculator  2.5 hours  upper esophagus  severe esophageal burns; coughing and choking with food ingestion; stricture  coughing and choking episodes for a year  endoscopic removal from esophagus; esophageal dilatation 2 months post ingestion  1 yr 
23  1998  NBIH  18 mo  unk  unk  unk  unknown  >12 hours  mid esophagus  esophageal and tracheal perforations; tracheoesophageal fistula  unknown  endoscopic removal; unknown procedures or outcome  unknown 
24  1999  Samad  4 y  CR 2032  20.0  lithium  sole of shoe  36 hours  mid esophagus  L hydropneumothorax; esophageal perforation  respiratory distress 6 h after removal  removal by esophagoscopy (3 attempts required); chest intubation for drainage of hydropneumothorax; esophageal perforation closed spontaneously  ~ 1 mo 
25  1999  Samad  5 y  CR 2032  20.0  lithium sole of shoe  5 hours  distal esophagus  esophageal perforation; child died from unrelated railway accident 3 months after discharge  dysphagia  endoscopy showed ulceration and necrosis of distal esophagus but battery perforated through esophageal wall and was removed surgically from the paraesophageal space;  esophageal perforation closed spontaneously  ~ 9 days 
26  1999 Grossweiler  1.5 y  unk  20.0  lithium  unknown  unk  esophagus  esophageal perforation; mediastinitis; esophageal stricture developed weeks later  difficulty swallowing food  endoscopic removal from esophagus  unk 
27  1999  NBIH  14 mo  unk  ≥20 mm  lithium  calculator  4 hours  upper esophagus (T2-T3)  "charred" esophagus; tracheoesophageal fistula  drooling and coughing after removal endoscopic removal from esophagus; location established 30 mins post ingestion but removal delayed to 4 hours because child had recently eaten; surgical repair of TE fistula 11 days post ingestion; pin-hole esophageal perforation at 8 months  > 8 mo 
28  1999  NBIH  11 mo  unk  ≥20 mm  lithium  remote car door opener  5 hours  mid esophagus  esophageal and tracheal burns (presume tracheoesophageal fistula based on surgical procedure); esophageal stenosis  unknown  endoscopic removal; surgical repair of trachea and esophagus 5 months post ingestion; tube feedings for protracted period; frequent esophageal dilations over 7 years resulting in 2nd esophageal reconstruction; only one additional dilatation required over next 2 years  > 7 yr 
29  2000  Chiang  20 mo  CR 2032  20.0 (based on imprint code; author gives battery
 23 mm) 
lithium  unknown  3 days upper esophagus (T2)  small tracheoesophageal fistula (negative pole in contact with anterior wall); pneumomediastinum; TE fistula healed by 11 weeks after foreign body removal  difficulty swallowing x 3 days, fever, drooling, intermittent choking, persistent cough, lethargy, tachypnea, mild dehydration, coarse breath sounds; intraesophageal bubbling on positive pressure ventilation  removal by rigid esophagoscopy under general anesthesia; nasojejunal tube inserted for feeding  > 11 wk 
 30 2002  Chan  1 y  unk  23  unk  unknown  1 day  upper esophageal orifice  tracheoesophageal fistula closed spontaneously after 8 months conservative therapy  dyspnea; stridor  endoscopic removal from esophagus  unk 
31  2002  NBIH  12 mo  CR 2032  20.0  lithium  digital camera  ~2 days  upper esophagus  10 mm ulcer of anterior wall of upper esophagus with necrotic center; ulcer extended 50% of esophageal circumference and 10 mm vertically; tracheoesophageal fistula just above carina; TE fistula persisted > 6 weeks; final outcome unknown  fever, wheezing, respiratory distress, refusing solids & liquids, increased WBC  removal by esophagoscopy; gastrostomy tube placed but cough and vomiting occurred with use so parenteral nutrition implemented and continued at home  unk 
32  2002  Anand  3.5 y  unk  ~21 mm  unk  unknown  10 days  upper esophagus
tracheoesophageal fistula diagnosed 1 day after battery removal, closed spontaneously with conservative management including tube feedings for 28 days after battery removal  dysphagia, cough, "cold" x 10 days, fever, weakness, drooling; removed 10 days post ingestion; severe coughing with oral intake after removal  removal by esophagoscopy from 3-4 cm below cricopharynx  unk 
33  2002  Tibballs  11 mo  DL 2025  20.0  lithium  unknown  9 hours  mid esophagus at T-4  very large tracheoesophageal fistula identified 7 days post ingestion (and post battery removal); unable to achieve adequate ventilation   crying, refusal of solids then decreased liquid intake, agitation, unable to sleep, stridor, choking, inability to swallow; hypoxia removal by esophagoscopy under general anesthesia;  urgent repair of the fistula done on cardiopulmonary bypass; 2 cm defect in esophagus; esophagus and tracheal defects sutured; remained intubated for 8 days; feeding began on the 9th post-op day; mild stricture of esophagus at level of the repair ~ 16 days 
34  2002  NBIH  2 y  CR 2032  20.0  lithium  ab belt (abdominal exerciser)
16.5 hours  upper or mid esophagus  tracheoesophageal fistula; esophageal strictures  stridor, gagging on foods, coughing up mucous  endoscopic removal; battery in esophagus on x-ray 2-3 hours post ingestion but removal delayed until 16.5 hours post ingestion as child had eaten; repeated dilatations of esophageal strictures  ~ 17 mo 
35  2002  NBIH  12 mo  CR 2032  20.0  lithium  unknown  ~2 days  esophagus  tracheoesophageal fistula upper respiratory symptoms including aspiration of food  2 weeks on total parenteral nutrition, then G-tube, later J-tube feedings; tube feedings continued for 1.5 months; endoscopy 2.5 months post ingestion showed complete healing of TE fistula  ~ 2.5 mo 
36  2003  Petri  12 mo  CR 2032  20.0  lithium  unknown  3-9 days in esophagus; passed spontane-ously  upper esophagus  at thoracic inlet  tracheoesophageal fistula (5 mm diameter) at C7-T1 level, likely developed 9 days post ingestion (based on symptoms) but not diagnosed by esophagoscopy until 28 days post ingestion  irritable, refusing food, drinking only small amounts, vomiting, fever, coughing with eating, rhonchi & stridor after drinking; recurring fever, dehydration and upper respiratory tract infections over 4 weeks; 30% of weight lost in first 18 days post ingestion battery passed spontaneously; hyperbaric oxygen treatment (3 week course) for TE fistula  6-7
37  2003  NBIH  20 mo  CR 2025  20.0  lithium  unknown  4-6 hours  esophagus  3 cm long burn of anterior esophagus; tracheoesophageal fistula evident 8 days post ingestion   pulmonary congestion removal by rigid endoscopy; surgical repair of TE fistula; transesophageal feeding tube for persistent leak around repair site which subsequently healed  spontaneously; repeated dilations for esophageal stricture required over next 7 months  > 7 mo 
38  2003  NBIH  13 mo  unk  unk  lithium  unknown  4-7 days  esophagus  esophageal perforation; tracheal stenosis; tracheoesophageal fistula; tracheal perforation; tracheitis; brain damage resulted from injury  progressive dysphagia and respiratory distress over 1 week endoscopic removal; perforated esophagus and TE fistula present; intubated; gastrojejunal feeding tube; tracheal reconstruction for tracheal stenosis; primary repair of esophageal perforation; additional surgical attempts to correct tracheal narrowing at anastomosis site  > 1 yr 
39  2004  Alkan  16 mo  CR 2032  20.0  lithium  unknown  ≥3 days  upper esophagus (T1-T2)  large tracheoesophageal fistula of left anterolateral wall of esophagus, 5 cm above carina  presented with choking, vomiting, unable to swallow; tachypnea and fever developed 6 hours after removal (esophagram showed no leakage); readmitted with dysphagia, fever, cough, drooling about 12 days post ingestion  removed by rigid esophagoscopy; antibiotics; steroids after removal; gastrostomy tube placed but TPN required due to tube retraction; TE fistula persisted after 5 weeks conservative management; surgical repair required; no fistula or stenosis on 10th post op day ≥ 8 wk 
40  2004  Lin  10 mo  unk  20  suspect lithium based on diameter  personal digital organizer  6 hours  upper (cervical) esophagus  circumferential 2nd to 3rd degree burns; esophageal perforation (small) described on post op day 1 and closed spontaneously by post op day 14  drooling; refused to eat; fever  removal by rigid esophagoscopy; bronchoscopy also done; perforation managed conservatively with esophageal rest (nasogastric tube feeding)  15 days 
41  2004  Imamoglu  2.5 y  unk  22.0  MnO2   calculator  17 days  upper esophagus  tracheoesophageal fistula  coughing and choking during feeding  removal by rigid endoscopy (first attempt failed, second successful); tracheostomy; NG tube feedings for 1 month after removal; surgical closure of fistula ~ 7 weeks post ingestion; asymptomatic after closure ~ 9 wk post ingestion 
42  2004  Okuyama  20 mo unk  20  suspect lithium based on diameter  unknown  1 week  upper esophagus  large (12 mm) tracheoesophageal fistula; post-op transient paralysis of left recurrent laryngeal nerve; mild esophageal stenosis required dilatation x 2; no recurrent fistula 6 months post op dysphagia x 1 week; battery identified on chest x-ray and removed; dysphagia, cough, dyspnea developed 1 week after removal treated with esophageal rest for 2 weeks after fistula noted; primary repair performed 4 weeks after ingestion of battery as respiratory symptoms and difficulty swallowing persisted; fistula divided and trachea and esophagus were repaired; sedated and paralyzed for 1 week post op for healing  
43  2004  cited in
2 pubs:
6 weeks   G13 11.6  manganese dioxide or silver oxide
(2 batteries) 
 unknown >24 hours  upper esophagus  tracheoesophageal lacerations and fistulas  respiratory distress progressing to respiratory failure and feeding problems; fever; tachycardia; high pitched cry; leukocytosis and thrombocytosis intubation and ventilation x 1 month; 2 batteries removed by esophagoscopy; jejunostomy tube feedings; pneumothorax required chest tube; tracheal resection and end-to-end anastomosis done 6 months later but one fistula persisted; hospitalized x nearly 1 year; esophageal repair planned in the future  > 1 yr 
44  2004  NBIH  20 mo  CR 2032  20.0  lithium talking book (suspected source) 
6 days esophagus noncircumferential burns with considerable granulation tissue and erosions; 2-3 months post ingestion esophagus showed significant scarring and damage of 1/3 of esophagus with ulcers that hadn't healed; improved by 7 months post ingestion 
coughing and decreased appetite for 6 days prior to removal; soft diet x 3 months; choking on food and required it to be cut into tiny pieces
endoscopic removal from esophagus; repeated esophagoscopy and dilations done several times over 7 months post ingestion  > 7 mo 
45  2004  NBIH  2 y  CR 2032  20.0  lithium  digital ear thermometer  8 hours  upper esophagus  esophageal burns; esophageal perforation detected on barium swallow 3 days post ingestion, healed 13 days post ingestion; stricture developed choking and coughing after ingestion; difficulty swallowing soft solids post ingestion  x-ray 2 hours post ingestion showed battery in esophagus but child transferred to another health care facility for removal; tube feedings until esophageal perforation healed; dilation of esophageal stricture required every 3-4 weeks for 14 months post ingestion; tube feedings until 16 months post ingestion; occasional difficulty with solid foods still reported 28 months post ingestion   > 16 mo
46  2004  NBIH  20 mo  CR 2016  20.0  lithium  remote control  10 hours  esophagus  esophageal burns; esophageal narrowing developed  screaming and vomiting immediately post ingestion; over month post removal, progressively increased difficulty swallowing solids; residual difficulty swallowing meat 1 year post ingestion  endoscopic removal (delayed because child transferred to another facility for removal); esophageal dilatation 2 months post ingestion; 2nd dilatation later > 1 yr 
47  2004  Stubberud
9 mo  unk  20.0  lithium (suspected based on diameter)  handheld video game (child found battery on floor)  15-16 hours  esophagus  battery seen in esophagus on x-ray 90 mins post ingestion but not removed until 15-16 hrs; esophageal and tracheal perforation detected 4 days post ingestion; 3 cm defect in posterior tracheal wall involving carina, right and left main stem bronchi; 4-6 cm esophageal defect  vomiting within 30 mins of ingestion; tarry stools, fever and stridor post removal evaluated and diagnosed as respiratory illness 2 days post ingestion; brought back 4 days post ingestion listless endoscopic removal; battery dislodged from esophagus into stomach then retrieved; surgical repair of esophageal and tracheal perforations 4 days post ingestion; ECMO required; mid section of esophagus removed and ends closed into pouches; severe intrathoracic infection and pneumonia, pneumothorax and difficulty with oxygenation treated with antibiotics, chest tubes, bronchoscopies and intubation; additional surgical procedure 1 week after first to repair trachea again; esophageal tissue used to reconstruct posterior trachea; additional surgery 13 weeks post ingestion - spit fistula; tube feedings continued > 28 months; esophageal reconstruction 18 months post ingestion with colonic interposition  > 28 mo 
48  2005  Bekhof
11 mo  unk  unk  unk  unknown  4 hours  upper esophagus (opposite T2)  swelling of esophageal mucosa; refused solid food; esophageal stenosis vomiting  flexible endoscopic retrieval failed; used rigid endoscopy to remove; esophageal dilatation required x 3  unk 
49   2006 NBIH  2 y  unk  size of quarter  unk (suspect lithium based on size)  toy phone  3 days  esophagus  severe inflammation of esophagus from 15-18 cm from incisors; ulceration, eschar and exudate on 3/4 of esophageal circumference (at 15 cm); mediastinitis; tracheoesophageal fistula noted 4 days post ingestion; esophageal perforation presumed as free air in mediastinum; TPN until 12 days  post ingestion - perforation healed and feeding started refused food, chest pain  endoscopic removal (rigid first, battery fragmented, largest piece fell into stomach; flexible esophagoscopy followed)  13 days 
50  2006  NBIH  11 mo  CR 2025  20.0  lithium  unknown  ~16 hours  upper 1/4 of esophagus  circumferential burns of esophagus; "grade 3"; lost to follow-up circumferential necrosis and eschar in upper 1/4 of esophagus endoscopic removal (delayed as thought was a coin); tube feeding for 12 days or more; lost to follow-up  > 12 days 
51  2006    NBIH  2 y  F  unk  20.0 lithium (suspected based on diameter) flashlight  12 days  esophagus  tracheoesophageal fistula (diagnosis not made until 6-7 months post ingestion although symptoms present from time of removal)  dysphagia and cough;  difficulty feeding and cough with drinking persisted x 6-7 months; resolved spontaneously by 20 months post ingestion  evaluated by pediatrician x 3 before diagnosis made (treated for URI); endoscopic removal; TPN x 1 month then began feeding  20 mo 
52  2006  NBIH  16 mo  CR 2025  20.0  lithium remote control  12 hours  upper esophagus severe circumferential burn; unable to swallow some solids for at least 15 months
gagging and choking; productive cough; decreased O2 sat
endoscopic removal   15 mo
53  2007  Nagao  8 y  unk  20.0  lithium  TV remote  2 hours  larynx  burns of postcricoid area and severe edema of laryngeal arytenoids; bilateral vocal cord paralysis  wheezing, respiratory distress, crying  endoscopic removal  unk 
54  2007  Hammond  15 mo  unk  22  lithium  unknown  ~1 week  upper esophagus  large  (2 cm diameter) tracheoesophageal fistula involving > 1/3 of tracheal posterior circumference for at least 4 tracheal rings; right vocal cord palsy
1 week of cough; battery removed and choking and coughing continued during feeding  tracheal repair with bovine pericardial patch; esophagus resected; gastric interposition; postop sedation and intubation for 3 weeks with nasojejunal nutrition; right vocal cord palsy presumed secondary to iatrogenic recurrent laryngeal nerve injury requiring tracheostomy; 3 esophageal dilations required  >3 mo 
55  2007  Bernstein  11 mo  CR 2032  20.0  lithium  unknown  5 hours  upper esophagus or hypopharynx; level of cricopharyngeus bilateral vocal cord palsy due to damage to recurrent laryngeal nerves in tracheoesophageal groove; corrosive injury of anterior and lateral hypopharynx; unable to speak
respiratory distress, bilateral vocal cord palsy  laryngoscopic removal; intubation x 5 days; prolonged nasogastric tube feeding  unk 
56  2007 NBIH  1 y  DL 2032  20.0  lithium  Tamagotchi (toy pet); battery removed by older sibling  3 hours  upper esophagus  circumferential 2nd and 3rd degree burns; tracheal narrowing and esophageal scarring
choking; respiratory distress; fever x 2 days; stridor and inability to eat solids persisted for > 10 months; lost to follow-up  intubated; feeding tube placed  > 10 mo 
57  2007  NBIH  2 y  CR 2032  20.0  lithium  bicycle computer  10 days  upper esophagus  2nd and 3rd degree ulceration on one side of esophagus, 1st degree on other side; strictures developed  refused food other than liquids; vomited and cried when given solids; fever; vomiting; melena; black, tarry stools  endoscopic removal from esophagus; hospitalized x 1 month; tube feedings for > 6 weeks; dilations required at 3 week intervals  > 4 mo 
58  2007  NBIH  11 mo  CR 2032  20.0  lithium  unknown  2-3 days  esophagus  persistent respiratory symptoms after removal required intubation and ventilator support; "poor prognosis" reported; lost to follow-up  vomiting, respiratory symptoms  endoscopic battery removal from esophagus  unk 
59  2007  NBIH  9 y  CR 2025  20.0  lithium  TV remote control  5 hours  lower esophagus  severe burns in esophagus  unknown initial symptoms; when feeding tube removed c/o chest pain and nausea after eating  endoscopic battery removal from esophagus; tube feedings required for 1 month post ingestion  > 6 wk 
60  2007  NBIH  14 mo  CR 2032  20.0  lithium  computer  8 hours  upper esophagus  esophageal perforation (not detected until 3rd endoscopy 5 weeks post ingestion); perforation into larynx described as "laryngeal cleft"  after removal: difficulty swallowing food and fluids; these precipitated coughing; persistent stridor, dyspnea and frequent aspiration of unthickened liquids after removal of feeding tube 3 months post ingestion; lost to follow-up  endoscopic removal (after transfer to a children's hospital); nasogastric feeding x 3 months  > 3 mo 
61  2008  Grisel  3 y  unk  ~ 20.0  lithium  unknown  12 hours  upper esophagus at thoracic inlet  injury through mucosa into muscular layer of upper esophagus; 9-10 mm tracheoesophageal fistula developed 7 days post ingestion 2 cm distal to cricoid cartilage and 5 cm above carina; negative pole facing anteriorly
coughing followed by fussiness, dysphasia, drooling; projectile vomiting  removal by rigid esophagoscopy about 12 h post ingestion; spontaneous closure of TE fistula 70 days post ingestion; TE fistula recurred 84 days post ingestion and failed to close spontaneously by 103 days; transtracheal surgical repair done  ~112 days 
62  2008  Slamon
17 mo  unk  20  lithium suspected  digital ear thermometer  ~4 days  mid esophagus  large tracheoesophageal fistula involving trachea and right mainstem bronchus with 2nd 1.0 cm fistula developing later into left mainstem bronchus; required ECMO due to the failure of conventional mechanical ventilation, but gas exchange continued to be inadequate; back to OR - found anterior wall of trachea absent and entire lower half of trachea into proximal mainstem bronchi bilaterally involved in fistula
respiratory distress, productive cough, fever; dysphagia; hypoxemia; ventilation, oxygenation and hemodynamics deteriorated with continued airway soiling through the TE fistula; ARDS, mediastinitis, and progressive atelectasis developed secondary to loss of minute ventilation through the fistula; complete consolidation of left hemithorax; gastric distention  removal by esophagoscopy; necrotic, friable, edematous mucosa; 2 lumens, one was a fistula to the trachea and right mainstem bronchus; gastrostomy tube placed; esophagus divided and stapled; flap of intercostal muscle mobilized and sutured onto the tracheal deficit; flap edema occluded the airway, requiring PEEP; 6 days after admission returned to OR because of bleeding; pericardial patch closure of the tracheal defect  was done and reinforced with the muscle flap; cervical esophagostomy; Horner's syndrome   
63  2008  Sudhakar  1.5 y  M unk  unk  unk  unknown  ~4 days  upper esophagus  esophageal ulcerations; pneumothorax; spondylodiscitis at T1-2 with prevertebral extension; narrowing of tracheal lumen; mediastinitis  coughing, vomiting, refusal of food, irritable, fever; neck pain, restricted neck movement and fever occurred 6 weeks after ingestion causing readmission 8 weeks post ingestion  removed by esophagoscopy; antibiotics for spondylodiscitis and mediastinits   14 days
64  2008  NBIH  9 mo  CR 2032  20.0  lithium  keyless car entry  ~5 days  esophagus  circumferential erosions, considerable edema, small esophageal perforation  vomiting and fever x 5 days before battery identified in esophagus; TPN x 2 weeks; continued difficulty swallowing solids 4.5 months post ingestion  endoscopic removal  > 4.5 mo 
65  2008  NBIH  12 mo  CR 2032  20.0  lithium  scale  8-9 hours  esophagus  tracheoesophageal fistula 1 cm diameter diagnosed 7 days post ingestion; fistula closed by 7 weeks post ingestion and child back on normal diet  child readmitted to hospital 7 days post removal with fever, difficulty eating and swallowing and vigorous coughing/choking with drinking  unsuccessful removal attempt 3-4 hours post ingestion; transferred to another hospital and removed 8-9 hours post ingestion; after fistula diagnosed, treated with NG feeding x 18 days  7 mo 
66  2008  NBIH  3 y  2032  20.0  lithium  unknown  4-5 days  upper esophagus  inflammation and erosion in proximal esophagus; circumferential injury with most damage anterior; perforation  coughing, choking, sore throat, inability to eat solids  brought to ER with initial complaints and sent home with diagnosis of URI; brought back 4 days later; endoscopic removal of battery from esophagus; TPN, then tube feedings; on clear liquids 3 weeks post ingestion then lost to follow-up  unk
(> 3 wk) 
67  2008  NBIH  13 mo  CR 2032  20.0  lithium  iHome remote control  7 days  upper esophagus  tracheoesophageal fistula noted at removal; injury not circumferential  vomiting and crying after ingestion of battery; developed cough and vomiting after each attempt to eat solids  child sent home from emergency dept with negative chest x-ray (battery above extent of first film); endoscopic removal; hosp x 11 days, sent home NPO on TPN and nebulizers; fistula healed by 6 weeks weeks post ingestion   
68  2008  NBIH  9 mo  CR 2025  20.0  lithium  remote control for DVD  5 days  esophagus  esophageal perforation; extensive circumferential burns; diverticulum formed where battery was lodged; trachea collapsed when attempted to extubate child post op; respiratory arrest occurred; child re-intubated; sepsis developed due to mediastinitis; home on pureed diet 2 weeks after battery removal; esophageal narrowing  cough (hospitalized x 2 for suspected croup before diagnosis made - no x-ray done); coughed up blood; unable to tolerate solids 3 months post ingestion, requiring pureed foods  endoscopic removal of battery from esophagus; esophageal dilatation 3 months post ingestion  > 3 mo
69  2009  Hamilton
9 mo  CR 2032  20.0  lithium singing Xmas card  ~9 hours  hypopharynx mucosal injury and vocal cord paralysis; required re-intubation after battery removal for dyspnea and stridor, then tracheostomy  dyspnea, stridor, vomiting  removal by rigid esophagoscopy; supraglottoplasty and tracheostomy 28 days after battery removal; home on tube feedings 38 days post removal; at 7 months post ingestion tracheotomy removed with significant vocal cord recovery  > 2 mo 
70  2009  Raboei  22 day    11.6  unk  toy  > 18 hours  upper esophagus (level of T1/T2)  circumferential burns; small perforation in esophageal wall; discharged after 7 days; returned to ED about 3 weeks post ingestion with dysphagia  no initial symptoms; dysphagia developed 3 weeks post ingestion  removal attempt by flexible endoscopy failed; battery ultimately removed by rigid endoscopy aided by use of Foley catheter; esophagoscopy, esophageal dilatation and laparoscopic gastrostomy done 3 weeks post ingestion; dilatation under general anesthesia done every 2 weeks x 3 months, every 3 weeks for the next 6 months, then monthly for 3 months; by 18 months tolerated oral feed  > 1 yr 
71  2009  NBIH  14 mo  CR 2025  20.0  lithium  unknown  9 hours  upper esophagus (level of clavicle)  mucosal burns and edema; tracheoesophageal fistula; required intubation and mechanical ventilation x 1 month  vomiting, respiratory distress, possible respiratory arrest, coughing with food and fluid intake  endoscopic removal from esophagus; j-tube inserted  > 3 mo 
72  2009  NBIH  23 mo  CR 2032  20.0  lithium  watch  8.5-9 hours  upper esophagus sphincter  burns of posterior and lateral esophagus; total vocal cord paralysis  initially choked, then vomited x 20 mins; presented 8 hours later to ED with stridor  battery removed with grasping forceps 8.5-9 hours post ingestion; reintubated due to post-op stridor and total vocal cord paralysis  unk
73  2009 report; occurred 2006  NBIH  20 mo  2032  20.0  lithium  bathroom scale  >6 weeks  upper (cervical) esophagus  esophageal strictures; vocal cord paralysis; requires tracheostomy and G-tube
respiratory symptoms x 6 weeks with multiple diagnoses: croup, allergies, asthma; losing weight and spitting out food; lost 1/3 of body weight; difficulty swallowing liquids  battery removed from upper esophagus just below vocal cords; battery eroded through esophagus (beyond esophageal lumen) and encapsulated with tissue; tracheotomy and G-tube required for at least 2.5 years  > 2.5 yrs (not yet feeding normally) 
Cases 1 to 73 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.
74  2009  NBIH  3 y CR 2025  20.0  lithium  battery package  3.5 hours  proximal esophagus  transmural esophageal necrosis bilaterally with mucosal injury anteriorly   witnessed ingestion; child initially asymptomatic; pain and drooling evident later battery removed endoscopically; NG tube placed; 3-day hospitalization; fed thru nasogastric tube for 4 weeks  > 6 wk 
75  2010  Tan & Gill (abstract)
14 mo  CR 2032  20.0  lithium  unknown  4 weeks (conflicting histories of symptom onset)  mid esophagus; negative pole facing posteriorly spondylodiscitis at T1-T2 intervertebral disc; erosive changes of T1 and T2; posterior bulging of intervertebral disc of T1-T2 into canal; polypoid lesion in proximal esophagus (granulation tissue); neck pain resolved shortly after initiation of antibiotics  esophageal battery identified and removed after 4 weeks of persistent cough (with 3 ED visits); abrupt onset of torticollis 5 weeks after removal of battery from esophagus; neck flexed with restricted range of motion and tenderness on palpation  battery removed by rigid endoscopy; spondylodiscitis treated with antibiotics (IV ampicillin/sulbactam) for 4 weeks (in hospital), then two weeks oral amoxicillin/ clavulanate after discharge   2 d
76  2010  NBIH  14 mo  CR 2032  20.0  lithium  automobile key fob  2 days  battery at cricopharyngeal level in esophagus  90% circumferential burns of esophagus with greatest injury posteriorly; partial vocal cord paralysis  child whispering, unable to cry; wheezing; difficulty swallowing  battery removed by endoscopy; nasogastric tube feedings x 7 weeks then advanced to pureed foods but had trouble swallowing liquids; readmitted to ICU for respiratory distress; tracheostomy 2 months after battery ingestion; feeding tube reinserted  at 3 mo still on tube feedings; follow-up ongoing 
77  2010  NBIH  17 mo  CR 2025  20.0  lithium  remote control  6 hours  proximal esophagus  circumferential, cork-screw-like burn; vocal cord paralysis; subglottic and peritracheal edema at level of cords  voice soft and hoarse; expiratory stridor; aspirates clear liquids; drooling; high fevers; retching; stridor when upset  endoscopic removal of battery; feeding through nasojejunal tube x 3 weeks, then G-tube inserted for feeding  at 2 mo still on tube feedings; follow-up ongoing 
78  2010  NBIH  16 mo  CR 20??  20.0  lithium  battery package  6 days  proximal esophagus just below cricopharyngeus; negative pole anterior  damage to 50% of esophageal circumference; persistent aspiration without evidence of TE fistula; persistent wheezing; esophageal stricture  stridor and cough x 6 days; stridor and wheezing for > 4 weeks post battery removal  endoscopic removal of battery; esophageal dilatation 2 months post battery removal  tolerating pureed foods only 2 mo post removal 
79  2010  NBIH  11 mo  CR ????  20.0  lithium  unknown  3 days  mid esophagus  severe esophageal damage requiring surgical resection of portion of esophagus; perforated esophagus; severe, recurring esophageal strictures requiring stent (failed) then mitomycin C  vomiting; refused
 to eat 
endoscopic removal of battery; portion of esophagus resected; cervical spit fistula; esophagus surgically reconnected 3 months after battery removal; esophageal stent placed; mitomycin C applied to resolve strictures  initially fed thru G-tube; 3 years post ingestion remains unable to swallow some solid foods 
80  2010  NBIH  20 mo  CR 2025  20.0  lithium  battery package  unk  unknown  2 "holes" in esophagus; subsequent scarring requiring 6-7 dilations  unknown  endoscopic removal of battery; 6-7 dilations  unk
81 2010  NBIH;
Australian Associated
12 mo  unk  unk  unk  toy  7 days  esophagus  tracheoesophageal fistula cold symptoms initially; vomiting 1 week after ingestion endoscopic removal; surgical separation (or resection) of esophagus with spit fistula and G-tube unk 
82 2010  NBIH  2 y  unk  20 mm  lithium  loose  18-19
proximal esophagus
just below cricopharyngeus; negative pole anterior
bilateral vocal cord paresis (R>L) with upper airway obstruction requiring tracheostomy 3 weeks after battery removal for > 15 months; L cord regained some function by 11 months; R cord still paralyzed at 15 months post ingestion  stridor, drooling, hoarse, fussy, unable to swallow; respiratory distress  endoscopic removal; tracheostomy  unk 
83  2010  Biswas  15 mo  unk  20 mm  lithium  unknown  ≥6 days
upper esophagus just below cricopharyngeus  tracheoesophageal fistula  presented with 6 days of cough and poor feeding; stridor evident  endoscopic removal of button cell; trachea partially obstructed by necrotic tissue overlying tracheoesophageal fistula; tracheostomy tube and gastrostomy tube placed; fistula closed spontaneously within 4 weeks   ~ 6 mo
84   2010  Kimball 9 mo  unk  20 mm  lithium  unknown  30 days  upper esophagus (intrathoracic)  erosion into esophageal muscularis with contained posterior perforation which healed spontaneously after 8 days of esophageal rest; esophageal stricture (50% narrowing) noted 6 weeks post removal  fever, otalgia and anorexia x 3 days; vomiting; persistent cough x 4 weeks; stridor; dysphagia  endoscopic removal of button battery; TPN; NG tube; single esophageal dilatation 3.5 months after removal  unk 
85  2010  Kimball  13 mo  unk  unk  lithium  unknown  7 days  upper esophagus (at thoracic inlet)  tracheoesophageal fistula; intermittent croup still occurring 3.5 years after injury  lethargy, progressive dysphagia, mild respiratory distress x 7 days  endoscopic removal of battery; gastrojejunostomy tube placed; tracheal and esophageal reconstruction including tracheal end-to-end reanastomosis, primary repair of the esophageal perforation and muscle interposition between the trachea and esophagus; recurring stridor and respiratory distress required multiple procedures to remove granulation tissue and apply mitomycin C unk 
86  2010  NBIH  18 mo  unk  ≥ 20 mm
unknown  DVD remote  2 weeks -
2 months 
proximal esophagus - cricopharyngeal area  esophageal strictures developed 2 months after removal  unknown initial symptoms; subsequent difficulty swallowing solids with gagging and drooling persisting more than a year after battery removal  endoscopic removal; dilatation every 1-2 months for about 18 months; mitomycin C used with improvement  > 1.5 yr 
87  2010  Parray  4.5 y  BR 2330  23 mm  lithium  unknown  >24 h  upper esophagus  Circumferential necrosis of upper esophagus. Developed esophageal perforation with subcutaneous emphysema, right tension pneumothorax, hypoxic episode and pneumomediastinum during endoscopic retrieval. Post-op mediastinitis with hemodynamic instability, 5 day intubated ICU stay. Required gastrostomy feeding tube and esophageal stent  24 hours dysphagia and food refusal  Multiple attempts over >90 mins to remove battery using McGill forceps, flexible endoscopy, and repeated air insufflations with battery adherent to mucosa; mechanical ventilation; chest tube; IV antibiotics and vasopressors; gastrostomy tube; esophageal stent   > 12 days
88  2010  Garey  22 mo  unk  unk  unk  unknown  unk  thoracic esophagus  esophageal perforation healed after 24 days esophageal rest (NPO)  unknown  unknown  unk 
89  2010 Garey
case is
on Fatal
Cases list,
case 32;
child died
nearly 2
years and
10 months

10 mo F unk 20  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 unk
90  2011  NBIH  9 y  unk
20  lithium  unknown  ≥4 days (based on symptom onset since ingestion not witnessed and denied by child) mid esophagus just above level of carina esophageal burns in posterior esophagus with eschar formation sparing anterior 2/3 of esophagus; esophageal perforation diagnosed at T3-T4 level on esophagram one day after removal; perforation reconfirmed 5 days after removal; healed spontaneously by 12 days post removal; esophageal stricture requiring dilation  child presented with sore throat, upper back pain, sensation of something in throat, inability to take solids, and emesis. Endoscopic removal of battery from esophagus. Dilating endoscopy 1 month post ingestion showed mid-esophageal granulation tissue and stricture; repeat barium swallow 4 months post ingestion was normal and no subsequent dilations were required  ~ 6 weeks 
91   2011 NBIH  18 mo  unk  unk  unk  unknown  ~11-12 weeks  upper esophagus at thoracic inlet  esophageal stricture at thoracic inlet requiring about 30 dilatations  Nonspecific symptoms followed unwitnessed ingestion, including rhinitis, otitis, strep pharyngitis, spitting up food, wheezing, stridor  Battery removed by flexible endoscopy. Adherent to tissue. Feeding began immediately post op and child managed at home. Dilation required about 30 times over next 2.5+ years, initially weekly, beginning about 3 weeks post removal  >2 years 
92  2011
NBIH  2 y  unk  unk  unk  unknown  suspected
8-12 months based on symptom duration 
mid esophagus  Tracheomalacia compromising the trachea by 60-70%. Granulation tissue and an esophageal stricture present immediately above the battery. Right innominate artery compression  8-12 months of dysphagia with regurgitation of solid foods and some liquids; weight loss Endoscopic removal of battery. Persistent midesophageal stricture with granulation tissue, polyploidy changes of mucosa and pseudo diverticula. G-tube placed. Esophagoscopy with dilation every 2 weeks then every month  unk 
93  2011  NBIH  3 y  unk  unk  unk  unknown  ~1 day  mid esophagus  "significant" corrosive damage in mid-esophagus and at the gastroesophageal junction. Injury extended into the muscular layer. No perforation. Unknown if later complications  Abdominal pain for a day after suspected coin ingestion  unknown  unk 
94 2011  NBIH  6 y  CR 2032  20.0  lithium  watch  4 hours  esophagus  Esophageal ulceration; esophageal stricture developed requiring dilation at least 3 times  Throat pain on swallowing  Endoscopic removal of battery from esophagus; repeated dilations  ~3 mo 
95  2011  NBIH  15 mo  unk  20  lithium  car key fob  5-14 days  mid esophagus (T6-T7 level on chest x-ray)  deep posterior ulcer; esophageal stricture  vomiting, diarrhea, high fever, drooling diagnosed as "GI bug"; melena developed; 7 lb weight loss  G-tube placed for feeding; repeated esophageal dilation required  unk 
96  2011  NBIH  12 mo  CR 2025  20.0  lithium  DVD remote  >2 days  esophagus  tracheoesophageal fistula; collapsed lung  Anorexia, fever, coughing up blood  surgical repair of esophagus with removal of 2 inches of esophagus; unsuccessful esophageal stent; prolonged hospitalization (>19 weeks); persistent leak in esophagus; g-tube for feeding; >65 total procedures  > 10 mo 
97  2011  NBIH  unk  unk  unk  unk  unknown  unk esophagus  tracheoesophageal fistula  dyspnea, vomiting, choking; respiratory arrest 2 days after battery removal but was resuscitated  endoscopic battery removal  unk;
> 1 mo 
98  2011  NBIH  15 mo  unk  20  lithium  remote control  1.5-2 weeks  esophagus  esophageal perforation  refusal to eat for 1.5-2 weeks; vomiting up everything  endoscopic removal of battery; esophageal perforation; surgical attempt to close the hole in the esophagus was only partially successful  unk 
99  2011  NBIH  14 mo  unk  20  unk  unknown  4 hours  upper esophagus (in neck); negative pole facing posteriorly  esophageal ulcer; periesophageal abscess (0.5*2.5 cm) in neck (retroesophageal) noted 9 days post ingestion; esophageal narrowing  vomiting, coughing, drooling  endoscopic removal of battery; TPN for about a week; several dilations for esophageal narrowing  > 5 mo 
100  2011  Spirers
9 mo  CR 2032  20.0  lithium  guitar tuner  14 hours  distal esophagus; just above gastroesophageal junction; negative pole facing posteriorly After endoscopic battery removal, the child had a mediastinal air leak (esophageal perforation) which slowly healed. He was sent home after a week in the hospital. Twenty-seven days after the ingestion and subsequent removal, the child developed an aortoesophageal fistula. He began to vomit, bleed, gasp, and experienced body stiffness and respiratory arrest. The child had developed an aortoesophageal fistula which was repaired, representing the first known survivor of a battery-induced AE fistula. Post operatively, the child has an esophageal stricture requiring dilation.  Child presented with coughing, spluttering, and inability to swallow fluids 12-15 hours post ingestion of the battery. Twenty-seven days after the ingestion and subsequent removal, the child began to vomit, bleed, gasp, and experienced body stiffness and respiratory arrest  The battery was removed endoscopically. Endoscopy was repeated when the child was re-admitted 27 days later. Endoscopy showed extensive esophageal ulceration with persistent ooze which was injected with adrenaline, causing further massive hemorrhage. Laparotomy was done, opening the esophagus and oversewing the posterior esophageal ulcer, enabling stabilization. A CT angio showed an aortoesophageal fistula, necessitating repeat surgery with resection of the damaged aortic segment and end-to-end anastomosis of the aorta. (Stabilization occurred over about 14 hours.) The child continues to require intermittent balloon dilation for an esophageal stricture.  unk;
> 5 mo 
101  2011  Wills
to remove
2 y  unk  unk  unk  flashlight  days  mid or upper esophagus  esophageal burn and perforation; tracheal damage; tracheoesophageal fistula  presented with days of worsening cough, loss of appetite and pneumonia-like symptoms; one month post removal unable to eat or swallow  2 surgical procedures including tracheal reconstruction; ventilated for 1 week; will require additional surgery for esophageal reconstruction  unk 
102  2011  NBIH  3 y  unk  20  lithium  unknown  >2 days  mid esophagus   tracheoesophageal fistula
initial cough and fever; anorexia; lethargy; unwitnessed ingestion 2 surgical procedures; feeding tube; 3 weeks in ICU  > 4 mo 
103  2011  Jarugula  5 mo  unk  < 12.4 mm
on x-ray
unk  unknown  ~24 hours  upper esophagus  granulomatous inflammatory mass eroding posterior mediastinum and C7, T1, and T2 vertebral bodies with spinal cord impingement; transient weakness of right upper limb, then left side; esophageal stricture  decreased feeding, cough and vomiting x 24 h; 2 weeks after removal developed noisy breathing and feeding problems  endoscopic battery removal; antibiotics; gastrostomy tube feeding; external spinal brace; repeated esophageal dilatation  unk 
104  2011  Jarugula  1 y  unk  < 24.6 mm
on x-ray) 
unk  unknown  24 hours  upper esophagus  esophageal necrosis 2-3 cm below cricopharynx; 3 cm tracheoesophageal fistula (evident on day 7)   unknown endoscopic removal; defunctioning esophagostomy; gastrostomy tube feedings  unk 
105  2011  Yalcin  2 mo  unk  unk  unk  unknown  unk  proximal esophagus  bronchopneumonia; tracheoesophageal fistula 4 cm proximal to carina; esophageal stenosis
hospitalized for bronchopneumonia requiring ventilator support (battery on chest x-ray misinterpreted as artifact  endoscopic removal; gastrostomy and jejunostomy; tracheoesophageal fistula closed spontaneously after 8 weeks of esophageal rest; repeated esophageal dilatation required over subsequent 2 years  2 yr 
106  2011  Valcin  18 mo  unk  unk  unk  unknown  unk  proximal esophagus  tracheoesophageal fistula 4 cm proximal to carina  readmitted a few days after battery removal due to coughing, pneumonia and respiratory difficulty  Gastrojejunal catheter placed for feeding but subsequently displaced; total parental nutrition given through central venous catheter for 3 weeks; tracheoesophageal fistula repaired surgically by interposition of a sternothyroid muscle flap  unk 
107  2011  Yalcin  5 mo  unk  unk  unk  unknown  unk  proximal esophagus  tracheoesophageal fistula; esophageal stricture; subglottic stenosis; dysfunctional swallowing  unknown  endoscopic removal of battery; tracheostomy; gastrostomy; tracheoesophageal fistula persisted 4 months after ingestion; fistula repaired surgically through cervical incision with muscle flap interposition; esophageal dilatation; anterior cricoid split with costal graft  unk 
108  2011  Wu  9 y  unk  20  lithium  unknown  6 hours  distal esophagus  contained perforation of distal esophagus resolved spontaneously in 8 days  unknown  endoscopic removal under fluoroscopic guidance (fluoroscopy used because of severe esophageal edema and necrosis impairing direct visualization of the battery); total parenteral nutrition x 8 days  >8 days 
109  2011  Kim  16 mo  unk  21.0  lithium  unknown  3 days  upper intrathoracic esophagus  tracheoesophageal fistula  cough  endoscopic battery removal associated with ventilatory compromise; surgical repair of tracheoesophageal fistula  unk 
110  2012
(occurr-ed in 2010) 
15 mo  CR 203?  ≥ 20.0  lithium  watch  <6 hours  upper esophagus at esophageal inlet  bilateral vocal cord paralysis; respiratory compromise; aspiration; anterior esophageal ulcer at cricopharyngeal level persistent stridor (before and after battery removal); persistent aspiration requiring G-tube placement; respiratory compromise required tracheostomy  battery removal via laryngoscopy; remained tracheostomy-dependent 2 years post ingestion; feedings by G-tube  >2 yr 
111  2012  NBIH; Young  19 mo  CR2032  20.0  lithium  unk possibly
10 days 
upper esophagus (intrathoracic);
negative pole
esophageal microperforation; abscess; spondylodiscitis; osteomyelitis; prevertebral cellulitis (C7-T2 involved); follow-up MRI at 4 and 12 weeks showed resolution  cough x 10 days prior to presentation, treated with amoxicillin for suspected pneumonia; trouble swallowing; fever; choking on food; neck pain unresponsive to ibuprofen developed 2 weeks to 1 month after battery removal; irritability, discomfort relieved by sitting upright, restricted neck movement, and tenderness to palpation battery removed by rigid esophagoscopy; esophagram showed no leakage on post-op day 1; discharged home on post-op day 4; spondylodiscitis treated with intravenous ampicillin/sulbactam for 6 weeks unk 
112  2012  Harjai  1 y  unk  15 mm  lithium  toy
ic harmo-
20 days  upper esophagus  large tracheoesophagal fistula at T1  sudden onset hoarseness followed by fever, cough, cyanosis, excessive drooling intubated for 72 hours for ventilatory support (prior to diagnosis of battery ingestion); battery missed on x-ray; endoscopic removal; surgical closure of fistula due to large size; interposed strap muscles of neck  unk 
113  2012  NBIH  6 y  CR 2032  20.0  lithium  unk  3 days  upper esophagus  circumferential burn; esophageal stricture  dysphagia; stridor after removal  endoscopic battery removal; unknown if dilation required  a few
114  2012  NBIH  2 y  unk  20  lithium
2 batter-
unk  upper esophagus (C6)  circumferential eschar; mild supraglottic and glottic edema; endoscopic dilation required 3.5 and 5 months post removal  fussy, drooling, vomiting, "gurgling"; hypoxic epidoses; stridor after battery removal; raspy voice  endoscopic removal of 2 batteries from upper esophagus; intubated  unk 
115  2012  NBIH  3 y  CR 2025  20.0  lithium  DVD
12 hours  distal esophagus  esophageal narrowing on imaging with no apparent impact on eating abdominal, throat and shoulder pain; lethargy  endoscopic removal of battery  unk 
116  2012  Soccorso  3 y  unk  20.0  lithium  unk  20 hours  distal esophagus  esophageal perforation; hydropneumothorax developed one day after removal  initial symptoms not described; battery mistaken for coin  thoracotomy; T-tube inserted in esophagus to create an esophago-pleura-cutaneous fistula; gastrojejunal tube  unk 
117  2012  NBIH  13 mo  unk  unk  unk  remote
unk (day
of ingest-
upper esophagus (above cords)  tracheal damage; severe burns  dyspnea; pain; coughing  tracheostomy required; feeding tube; multiple surgical procedures and hospitalizations  unk 
118   2012  NBIH 2 y  CR 2032  20.0  lithium  night
to crib 
5 hours  mid esopahgus  esophageal perforation (healed spontaneously); circumferential necrosis chest pain  endoscopic removal of battery; esophageal dilation  2-3 weeks 
119  2013  NBIH  23 mo  unk  20  lithium  unk  unk
(11 hours to 3 days) 
proximal esophagus at thoracic inlet  tracheoesophageal fistula; bilateral vocal cord paralysis; esophageal stricture; narcotic and benzodiazepine dependency; cardiopulmonary arrest (resuscitated)  respiratory distress, decreased oral intake, drooling, cough, fever, stridor, tachypnea, decreased O2 sat  surgical repair of tracheoesophageal fistula with end-to-end anastomosis; tracheostomy x 18 months; J-tube for feeding > 22 months  >22 mo 
120  2013  Panella
(patient D) 
8 mo  unk  20  lithium
based on
unk  >72 hours  proximal esophagus  esophageal perforation with neck abscess  coughing and fussiness x 1 week prior to presentation; sent home from ED; returned next day with vomiting, diarrhea, and inability to swallow secretions  endoscopic removal of battery; feeding tube placed; anterior neck swelling developed on post op day 2 and neck abscess communicating with esophagus was drained in OR; 2 weeks later a contained fistulous tract noted and drained externally - resolved in another 7 days; hospitalized 24 days; child asymptomatic but lost to follow-up  unk 
121  2013  Panella
(patient E) 
34 mo  unk  20  lithium
based on
unk  24 hours  proximal esopahgus (just below throacic inlet)  tracheoesophageal fistula 4.5 cm below vocal cords  difficulty swallowing; excessive drooling; about 8 days after removal developed cough and decreased oral intake and was rehydrated; 4-5 weeks after removal again had hesitancy with feeding and barium esophagogram showed extravasation of barium (TE fistula)  endoscopic removal of battery; feeding tube placed; gastrostomy tube placed; transcervical TE fistula repair wth interposition of sternohyoid rotational muscle flap  ~3 mo 
122  2012  Simonin  16 mo  CR 2032  20.0  lithium  remote
48 hours  proximal esophagus  bilateral vocal cord paralysis; esophageal erosion; infraglottic edema  acute respiratory distress; stridor; cough  endoscopic battery removal; intra-vocal cord steroid injection; glottic balloon dilatation; unilateral posterior cordotomy  unk (sent home on enteral feeding on day 19) 
123  2012  Malik  10 mo  unk  ~20 mm  lithium  unk  unk  mid esophagus  tracheoesophageal fistula developed 4 days after battery removal; large defect on posterior wall of distal trachea including the carina; initial portions of right and left mainstem bronchi were absent; esophageal stenosis at surgical anastomosis site  cough and irritability present initially; 4 days after removal child presented with respiratory distress, tachypnea, tachycardia, coarse bilaterial wheezing, rhonchi and stridor  endoscopic removal of battery from esophagus; surgical repair of tracheoesophageal fistula included 1) esophageal isolation, cervical esophagostomy, and gastrostomy tube placement; 2) total esophagectomy via right thoracotomy, and 3) reverse gastric tube esophageal replacement  >4 yr 
124  2013  Russell  15 mo  CR 2032  20.0  lithium  for baby monitor; left loose on nightstand  6 hours  mid esophagus (at level of carina)  7 mm tracheoesphageal fistula between esophagus and right mainstem bronchus; narrowing of proximal right mainstem bronchus persisted after spontaneous closure of fistula  no initial symptoms; one week after removal child developed fever, tachypnea, oral refusal, diarrhea and abdominal distension  battery removed by rigid esophagoscopy; tracheoesophageal fistula closed spontaneously in one month with nasogastric feeding and esophageal rest (without operative repair)  > 6 weeks 
125  2013  Eshagi  10 mo  unk  ≥20.0  lithium  unk  >5 days  upper esophagus  spondylodiscitis (diminished height of T1-T2 vertebral disc and irregularity of adjacent endplates on MRI)
5 days of irritability and crying with refusal to eat and drink; fever developed; child admitted for diagnostic workup and battery found in upper esophagus on x-ray; battery expelled through spontaneous vomiting prior to esophagoscopy and the procedure was not done; about a month after the initial symptoms, the child developed neck stiffness, restricted neck mobility (fixed in hyperextended position), and fever, with tenderness over upper thoracic vertebrae  intravenous antibiotics x 6 weeks with symptom resolution unk 
126  2013  NBIH  3 y  CR 2025  20 mm  lithium  unk  6-7 hours  mid esophagus  5 cm partial thickness, non-circumferential burn of esophagus; fever developed post removal; esophageal stricture   crying; pain battery removed endoscopically; NG feeding x 17 days; one dilation required 2 months post ingestion  3 mo 
127  2013  NBIH  7 days  AG 13 (2 batteries)  11.6 mm  MnO2  lighted tweezers; fed batteries by sib  unk  2 batteries ingested: esophagus (1); stomach (1)  tracheoesophageal fistula; necrosis of fingers and toes; renal infarction  respiratory failure; hypoperfusion of extremities following embolization of thrombus (ECMO complication); renal infarction  battery removal; ECMO respiratory support; tube feeding; multiple surgical procedures to repair esophageal and tracheal damage  unk 
128  2013  Media
18 mo  unk  unk  unk  unk  many days  esophagus  esophageal perforation  fever, lethargy, coma, hoarse, cough  endoscopic removal from esophagus; G-tube feedings  unk 
129  2014  Hand  10 mo  unk  unk  unk  unk  18 hours  mid-upper esophagus  esophageal perforation (right posterolateral); pneumothorax evident day after removal; noncircumferential mucosal burn; 50% stenosis of esophagus at site of burn  "decompensated" on anesthesia induction for chest tube insertion requiring immediate needle decompression of pneumothorax  difficult endoscopic removal of battery from esophagus (embedded in wall); emergent chest tube insertion to decompress pneumothorax; pneumothorax healed spontaneously  >12 days 
130  2014  Pandey

2 y  unk  20-23 mm  lithium  unk  5 days  mid esophagus  2 cm tracheoesophageal fistula  dehydration, fever, tachypnea, tachycardia, feeble pulses  endosopic removal of battery immediately followed by thoracotomy and primary repair of the tracheoesophageal fistula  unk 
131  2014  Pandey

3 y  unk  22 mm  lithium  unk  unk  upper or mid-esophagus  retropharyngeal abscess; tracheoesophageal fistula (mid esophagus) diagnosed at 4 weeks  presented with swelling of neck, dyspnea, inability to swallow saliva 2 days following removal of a reported 22 mm (likely 20 mm enlarged on x-ray) lithium cell from the esophagus; developed choking and coughing when feeding begun at 4 weeks  endoscopic removal of battery; antibiotics; feeding gastrostomy; thoracotomy and repair of tracheoesophageal fistula  unk 
132  2014  Ruhl  17 mo  unk  unk  lithium  unk  ~4 months  cervical esophagus  esophageal ulceration; esophageal double-lumen (parallel false lumen); esophageal stenosis  presented with 4-month history of cough, reflux and failure to thrive  flexible endoscopic removal; segmental resection of severe esophageal stricture with primary anastomosis; subsequent mild stenosis treated with two esophageal dilations  unk 
133  2014  Jump  28 mo  unk  20 mm  lithium  unk  ≥6 days  upper esophagus  mediastinitis; discitis and osteomyelitis of T1 and T2; mild stenosis of proximal esophagus  lethargy; refusal to lie supine or walk  removal by rigid esophagoscopy; hospitalized for one month; antibiotics; gastrostomy tube; cervical brace  1-8 mo 
134  2014  Liao
11 mo  unk  unk  unk  unk  7 days  mid esophagus 
tracheoesophageal fistula  dysphagia; fever; cough  35 day hospitalization; feeding tube; closed spontaneously after 4 months   
135  2014  Liao

3 y  unk  unk  unk  unk  4 days  esophagus  tracheoesophageal fistula  unknown  28 day hospitalization; feeding tube; antibiotics; fistula closed spontaneously   
136  2014  Liao

3 y  unk  unk  unk  unk  5 days  esophagus  tracheoesophageal fistula  unknown  21 day hospitalization; feeding tube; antibiotics; fistula closed spontaneously   
137  2014  NBIH  16 mo  unk  20 mm  lithium  toy  10 hours  upper esophagus  esophageal perforation; noncircumferential necrotic area about 270 degrees around esophagus; negative battery pole facing posteriorly  initial gagging and choking  TPN; esophageal perforation detected about 17 days post ingestion; closed spontaneously   
138  2014  Hamawandi  30 mo  unk  unk  unk  unk  ≥7 days
esophagus  esophageal perforation  unknown  surgical closure; gastrostomy tube feeding; chest tube drainage; antibiotics x 28 days; 36-day hospitalization   
139  2013  NBIH  2 y  unk  unk  lithium  key fob  unk  esophagus  unspecified esophageal burns   unknown  feeding tube in place for one month, expected to be in place for 6 months   
140  2013  NBIH  14 mo  CR 2032  20 mm  lithium  unk  ~5 hours  upper esophagus  circumferential burns of esophagus; extensive swelling required 3 days intubation; readmitted 16 days post ingestion with dehydration and 6-7 lb weight loss; avoiding meat one year later  cough; dehydration; weight loss  endoscopic removal (multiple attempts required before successful)   
141  2013  NBIH  17 mo  CR 2016  20 mm  lithium  book light ~15 hours  upper esophagus  esophageal burns; mediatstinitis (on MRI) with small air pockets treated with antibiotics  initial symptoms: vomiting; unable to swallow  endoscopic removal from esophageal inlet (negative pole posterior); intubated x 4 days; hospitalized x 16 days; antibiotics; gastrostomy tube   
142  2013  NBIH  13 mo  unk  20 mm  lithium  remote control  3-30 days  mid esophagus  tracheoesophageal fistula visible at time of battery removal (described as large gaping slash fistula)  respiratory distress; wheezing; fever; poor feeding  endoscopic removal from mid esophagus; intubated x 1 month; gastrostomy tube; surgical repair of fistula planned but lost to follow-up   
143  2014  NBIH  14 mo  unk  >20 mm  lithium  unk  ~4-6 weeks esophagus  respiratory arrest; esophageal ulcer  choking or vomiting x 4-6 weeks whenever child ate; respiratory arrest during or after placement of tubes in ears; intubated, then battery in esophagus identified; barking cough endoscopic removal; intubation   
144  2014  NBIH  3 y  2025  20 mm  lithium  video camera  11.5 hours  upper esophagus  circumferential burn with necrosis; esophageal narrowing and some difficulty swallowing  refusing food; pain; difficulty swallowing endoscopic removal   
145  2014  NBIH  10 mo  unk  20 mm  lithium  keychain  <24 hours  upper esophagus  small esophageal perforation resolved spontaneously; suspected abscess formation at anterolateral aspect of upper thoracic esophagus  hoarse cry; refusing solids; coughing; drooling  difficult removal by rigid esophagoscopy   
146  2011  Khaleghnejad
9 mo  unk  5 mm  unk  unk  ≥5 days  proximal esophagus  tracheoesophageal fistula  presented with cough and cyanosis x 5 days, with cough, dyspnea and cyanosis continuing after removal  battery removal by laryngoscopy; tracheoesophageal fistula repaired surgically   
147  2011  Khaleghnejad
2.5 y  unk  unk  unk  unk  ≥8 months  distal esophagus  tracheoesophageal fistula into right bronchus  vomiting after ingestion of solid food and productive cough x 8 months  battery removal by esophagoscopy; thoracotomy to repair tracheoesophageal fistula   
148  2011  Khaleghnejad
2 y  unk  unk  unk  unk  ≥8 days
unk tracheoesophageal fistula  presented with dysphagia and choking x 8 days; fever developed post removal  thoracotomy to repair tracheoesophageal fistula   
149  2011  Khaleghnejad
3 y  unk  unk  unk  unk  ~1.5 months  upper esophagus tracheoesophageal fistula  presented with cough, dyspnea, dysphagia and vomiting  Tracheoesophageal fistula repaired through neck incision   
150  2014  Fuentes  7 y  unk  20 mm  lithium  unk  6 hours  upper esophagus  esophageal stenosis  initial sialorrhea and vomiting  endoscopic removal of battery; balloon dilatation x 4 beginning 4 weeks post ingestion   
151  2014  Fuentes  2 y  unk  20 mm  lithium  unk  a few hours  upper esophagus  esophageal stenosis  vomiting  endoscopic removal of battery; 3 cm burn; esophageal dilatation required (once)   
152  2014  Zapf  20 mo  2032  20 mm  lithium  unk  7 hours  upper esophagus  severe necrosis of esophagus; tracheoesophageal fistula developed between days 4 and 10; mediastinal emphysema  presented with cough and dyspnea; stridor and severe dyspnea after removal  endoscopic removal; nasogastric tube; after 4 months the fistula was not closing spontaneously thus surgical closure was performed; revision of the closure was required due to persistent leakage   
153  2014  Tiedeken  3 y  unk  20 mm  lithium  unk  6 months  mid esophagus  esophageal tear; mediastinitis; esophageal stricture  persistent cough for 6 months diagnosed as GERD and asthma, worsened over the 2 days prior to presentation  endoscopic removal showed thin, friable esophageal wall, ulceration and abundant granulation tissue formation; endoscopic balloon dilations x 2 for strictures   
154  2015  NBIH  3 y  unk 20 mm  lithium bathroom scale; new battery  4 hours esophagus  esophageal perforation (free medistinal  air on CT) treated conservatively with TPN and hospitalization for 1 week; repeat CT confirmed healing of perforation  pain, vomiting food, "looked quite unwell"  removed endoscopically 4 hours after ingestion   
155   2014 Youth
8 mo  unk  unk  lithium  unk  ~4 days  upper esophagus  trachesophageal fistula; vocal cord paralysis secondary to abscess around recurrent laryngeal nerve
wheezing and coughing on presentation; bronchiolitis initially suspected and treated with inhaler  esophagectomy and cervical spit fistula; feeding gastrostomy tube; multiple major surgical procedures (at least 5) in the 3 months post ingestion to attempt tracheal and esophageal repair; still on ventilator 5 months post ingestion; suffered seizures, brain bleeds, infections   
156  2015  Gopal M  3 y  unk  ≥20 mm
lithium unk 36 hours upper esophagus  large tracheoesophageal fistula at C7-T1 level   difficulty swallowing prior to removal; cough and fluid aspiration evident on first post-op day  removed by rigid esophagoscopy; surgical repair through combined right cervical incision and median sternotomy with resection of a segment of both the trachea and esophagus followed by primary anastomosis; esophageal leakage noted on 12th post-op day and esophageal diversion was accomplished with a cervical esophagostomy and feeding gastrostomy; esophageal continuity was re-established 3 months later   
157  2015  Peters  4.5 y  unk  unk  unk  unk  ~6 months  thoracic esophagus trachesophageal
unknown  removed by rigid esophagoscopy; feeding gastrostomy; delayed repair of TEF (with resection of esophageal segment) after 6 weeks of esophageal rest; 2 hospitalizations (21 days total); 2 esophageal dilations subsequently required  unk 
158  2013  Hall  6 weeks  unk  unk  unk  unk  unk  upper esophagus  esophageal perforation; hoarse voice and left recurrent laryngeal nerve palsy noted post esophageal reconstruction (unclear if present pre-op) unknown  cervical esophagostomy; feeding gastrostomy   
159  2013  Hall  5 y  unk  unk  unk  unk  unk  upper esophagus trachesophageal fistula; left vocal cord paralysis  unknown  cervical repair of tracheosphageal fistula   
160  2014  Plumb  3 y  unk  unk  unk  unknown  ~24 hours  mid esophagus discitis and osteomyelitis at T3-T4 with extensive paraspinous phlegmon and mediastinitis diagnosed 5 weeks after battery removal; esophageal perforation with contained leak posterior to esophagus; mild esophageal stricture  child with underlying hydrocephalus, hypotonia, developmental delay and pulmonary hypertension presented with tachypnea, decreased tolerance of food and low grade fever; battery ingestion diagnosed and battery removed; 5 weeks post battery removal child presented with fussiness with feeding, pain with sitting up or rolling over, increased work of breathing and intermittent fevers  endoscopic battery removal; prolonged IV antibiotics and esophageal rest   
161  2014  Kankane  18 mo  unk  20 mm  lithium  unknown  >1 month  mid esophagus   tracheoesophageal
 fistula at T1-T2

presented with fever, cough, shortness of breath, decreased food intake, vomiting, drooling; treated with oxygen, IV fluid and antibiotics for more than a month without improvement; severe acute malnutrition developed; tachycardia, tachypnea, nasal flaring, retractions  feeding jejunostomy x 6 weeks followed by surgical repair of fistula   
162  2015  NBIH  12 mo  2025  20 mm  lithium  glasses for use with 3D TV  ≥6 days
mid esophagus  mediastinitis; esophageal stricture presented with "rattling chest" for several days  difficult removal due to granulation tissue; prolonged TPN; dilation of esophageal strictures required every 4 weeks for at least 5 months  unk
163  2014  Kieu  14 mo  CR 2032  20 mm  lithium  unknown  1-5 days  proximal esophagus  spondylodiscitis (polypoid granulation on posterior esophageal wall and inflammatory phlegmon adjacent to spondylodiscitis at C7-T3)  presented with abnormal neck posturing, poor feeding, drooling, cough, fever; battery removed; one week later child presented again with neck hyperextension and inspiratory stridor  battery removed by esophagoscopy; IV antibiotics (ticarcillin/clavulanate)   
164  2015  Makhubu  16 mo  unk  20 mm  lithium  unknown  2 days  proximal esophagus  tracheoesophageal fistula(s); cardiac and respiratory arrests leading to brain edema requiring brain surgery  initial: vomiting; rash; difficulty breathing; fever  battery removal by endoscopy; esophageal diversion (cervical spit fistula); multiple attempted repairs of TE fistula   
165   2014 Daily-
18 mo  unk  ~20 mm  unk  unknown  8 weeks esophagus  esophageal stricture  initial: vomiting with eating x 8 weeks; listless; weight loss; struggling to breathe  battery removal; esophageal dilation x 5   
166   2014 Daily-
11 mo  unk  unk  unk  kitchen
20 hours  esophagus  esophageal stricture (11 cm scar in esophagus)  initial choking and crying; fever after removal; unable to eat solids for 2 months  battery removal; dilation  2 mo 
167  2015  Smith  4 mo  unk  11.6  unk  unknown  >155 hours  upper esophagus  corrosion of spine; 3 vertebrae damaged and collapsed; battery mistaken for shirt button on x-ray  initial cough and breathing problems; battery removed > 15 hours after ingestion; 4 weeks later presented with corrosion of part of spine  battery removal; 8 months in body cast; 5 years later he can walk but has motor limitation (unable to fully raise head)   
168  2015  Barabino  5 y  CR 2032  30.0  lithium  unknown  ~3 days  mid esophagus  esophageal perforation developed 7 days after battery removal; severe, deep mildly bleeding ulceration of esophageal wall  presented with 3 days of epigastric pain and history of possible coin ingestion  esophagoscopy initiated but when severity of ulceration noted, a lateral thoracotomy was done to exclude damage to aorta; direct contact between battery and aorta excluded by transillumination; battery pushed to stomach then removed; parenteral nutrition, omeprazole and antibiotics started; esophageal perforation developed 7 days after battery removal and was treated conservatively with full recovery   
169  2015  Onotai  3 y  unk  ~20 mm  lithium  unknown  ~6 months  upper esophagus  esophageal stricture  presented with 6 month history of poor feeding, chronic cough and progressive difficulty breathing; drooling; mild respiratory distress. removal by rigid esophagoscopy; serial esophageal dilations required; 3 month hospital stay  >3 mo 
 170 2015  NBIH  2 y  unk  20.0  lithium  unknown  6-7 days  distal esophagus  mediastinitis; esophageal erosions; pericardial effusion vomiting; altered diet but able to eat soft food and drink fluids; dark stools  removed endoscopically  unk 
 171 2015  Singh  10 mo  unk   ≥20 
lithium unknown  unk  cricopharyngeal area  bilateral vocal cord palsy; tracheostomy required for delayed acute respiratory distress stridor; refusing food; drooling; dramatic improvement after battery removal, but stridor recurred about 2 weeks post removal and tracheostomy required 2 months post removal for acute stridor with inability to intubate  removed endoscopically; tracheostomy  unk 
172  2015  NBIH  21 mo  unk  20.0  lithium  unknown  4 hours  cricopharyngeal area  left vocal cord paralysis on presentation; extensive necrosis of esophageal wall; esophageal perforation (right side); 1 cm diameter tracheoesophageal fistula developed over a few days 3 cm from carina in upper mediastinum   unknown endoscopic removal of battery; surgical repair of tracheoesophageal fistula  unk
173  2015  Schroter  21 mo  unk  ≥20
lithium  unknown  3-6 weeks  anterior to upper esophagus  mid-tracheal narrowing due to compression of posterior tracheal wall by battery; bilateral vocal cord paralysis; esophageal stricture 3-week history of decreased oral intake and upper respiratory symptoms (cough, congestion), eventually refusing to eat anything for 3 days, spitting out any food or water; 5 lb weight loss over 3 weeks; lethargy (decreased tone and strength); severe dehydration (sunken eyes, dry mucous membranes, one wet diaper in 24 hours, poor skin turgor, tenting, delayed capillary refill); malnutrition; esophageal edema (esophagus separated anteriorly from tracheal air column on chest x-ray; stridor developed over the few months post removal esophagoscopy performed but battery not visualized and appeared to have eroded through the esophageal wall (anterior esophageal mass seen); debris and inflammation in esophagus; bronchoscopy showed considerable mid tracheal narrowing; battery removed surgically through a neck incision - battery walled off between esophagus and trachea; numerous esophageal dilations required due to stricture and diverticulum development; stridor developed over the few months  post removal and bilateral vocal cord paresis and persistent airway compression were noted requiring a tracheostomy tube unk 
 174  2014 NBIH 20 mo  2025  20.0  lithium  unknown  ~3 days
proximal espophagus  esophageal stricture; necrotic areas visualized in esophagus  reported asymptomatic initially; after removal some difficulty swallowing; choking on food  endoscopic removal of battery; repeated esophageal dilation; speech therapy unk 
 175  2014 NBIH
20 mo  unk unk  unk unknown  unk  proximal espophagus 
tracheoesophageal fistula; vocal cord paralysis (unilateral, complete); esophageal stricture  presented with drooling; pointing to neck  endoscopic removal of battery; multiple esophageal dilations; gastrostomy tube for feedings; spit fistula and esophageal hiatus closure to allow TEF to heal; reanastomosis of esophagus and spit fistula takedown  unk 
 176  2015 NBIH
11 mo  M unk  unk  unk unknown  unk  proximal espophagus 
unilateral vocal cord paralysis  presented with cough, dysphagia, fever; unable to drink safely  endoscopic removal; gastrostomy tube for feedings  unk 
 177 2015  NBIH
15 mo  unk  20.0 lithium unknown  unk  proximal espophagus    esophageal stricture presented with decreased oral intake; coughing/spitting after eating; fever; upper respiratory symptoms endoscopic removal; esophageal dilation; multiple esophageal dilations; hospitalized ~ 6 days
 178 2015  NBIH  5 y  2032L  20.0  lithium  toy  2-3 days  distal esophagus  esophageal perforation  chest pain and refusal to eat or drink x 48 hour  endoscopic removal after CT ruled out vascular involvement; total parenteral nutrition; 2 week hospitalization unk 

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