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Nonfatal Button Battery Ingestions with Severe Esophageal or Airway Injury: 167 Cases

Case # Source
(Year, Author)
Age Sex Imprint Diam
Chemistry Intended Use Time to Removal Battery Location Complications Signs & Symptoms Procedures and Treatment Approximate Days to Normal Feeding
1 1982 cited in 2
 Janik (1982);
Votteler (1983) 
25 mo M EPX 825 23 MnO2 camera 5 days upper
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 months
2 1983 Litovitz &
16 mo U EPX 825 23.0 MnO2 unk 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
 Carithers & 
Birck (1984);
Maves, Lloyd, &
 Carithers (1986);
Litovitz (1985);
10 mo F EPX 13 15.6 mercuric oxide camera ~18-22 hours upper
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 years
4 1984 McNicholas 3 y M unk unk alkaline camera ~3 weeks upper
4 cm posterior esophageal wall inflamed; tracheoesophageal fistula (.5 cm wide, 2 cm long) 4 cm above carina chest infection nonresponsive 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 dilatations ~2 months
5 1986 Van Asperen 9 mo F unk 16 mercuric oxide camera ~8 days upper
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 dilatations 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 months
6 1987 Kost 18 mo M unk 20 lithium unk 29 days upper
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 dilatations, progressing to less frequent dilatations > 7 months
7 1987 Rivera &
3 y M PX 825 23.0 MnO2 unk ~48 hours upper
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 dilatations required for > 2 years > 2 years
8 1988 Sigalet 4 mo M M 76 11.6 unk camera ~30 hours upper
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 cricopharyngeous; 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  
9 1989 Vaishnav 16 mo F unk 20 (originally reported
as 10 mm but
parent re-interviewed
 by author)
MnO2 watch ~ 4 weeks upper
 at thoracic
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 M unk unk unk unk > 48 hrs esophagus
suspected tracheoesophageal fistula (based on tx provided) Initial dx: croup endoscopic removal; tracheostomy; esophageal resection > 1 mo
11 1990 NBIH child U 386 A 11.6 MnO 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 F BR 2016 20 lithium watch 9.5 hours upper
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 years
13 1993 Gordon 18 mo F unk unk unk hair dryer 3 days upper
esophageal perforation (blind pouch posterior to esophagus); stricture developed at 7 weeks requiring resection with primary anastomosis; 3 subsequent esophageal dilatations required dysphagia x 3d prior to removal removal by esophagoscopy > 2 months, < 2 years
14 1993 NBIH 11 mo M CR 2025 20 lithium handheld
6.75 hours distal
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 months
15 1993 NBIH 8 y M unk unk unk watch 1 day left
left lower lung collapsed; circumferential burn to bronchus pleuritic chest pain removal by rigid bronchoscopy unk
16 1994 NBIH 18 mo F CR 2016 20 lithium calculator ~ 4 days esophagus
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 years
17 1996 Senthilkumaran 5 mo M unk ~ 22 unk toy 12 days upper
tracheoesophageal fistula at T2-T3  difficulty breathing, fever, choking; hospitalized x 10 days for recurring chest infection prior to dx; 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 weeks
18 1996 NBIH 13 mo M unk 20 lithium camera <=2.5 hours upper
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 M unk unk unk unk 3 hours esophageal
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 days
20 1997 NBIH 3 y F PX 825 23 MnO2 unk > 3 days cervical
severe burns in esophagus and trachea inability to swallow; evaluated by physician and presumed viral illness cervical esophagostomy; gastrostomy placement unk
21 1997 NBIH 11 mo M CR 2016 20.0 lithium unk > 24 hours upper
circumferential burns of esophagus; esophageal stenosis drooling; refused to eat or drink stent placed in esophagus for 3 weeks; dilatation x 2 > 5 weeks
22 1997 NBIH 8 mo M unk > 21 mm lithium calculator 2.5 hours upper
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 year
23 1998 NBIH 18 mo F unk unk unk unk > 12 hours mid
esophageal and tracheal perforations; tracheoesophageal fistula unk endoscopic removal; unknown procedures or outcome unk
24 1999 Samad 4 y F CR 2032 20.0 lithium sole of shoe 36 hours mid
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 month
25 1999 Samad 5 y F CR 2032 20.0 lithium sole of shoe 5 hours distal
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 Gossweiler 1.5 y M unk 20.0 lithium unk unk esophagus  esophageal perforation; mediastinitis; esophageal stricture developed weeks later difficulty swallowing food endoscopic removal from esophagus unk
27 1999 NBIH 14 mo M unk >= 20 mm lithium calculator 4 hours upper
"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 months
28 1999 NBIH 11 mo M unk >= 20 mm lithium remote car
 door opener
5 hours mid
esophageal and tracheal burns (presume tracheoesophageal fistula based on surgical procedure); esophageal stenosis unk endoscopic removal; surgical repair of trachea and esophagus 5 months post ingestion; tube feedings for protracted period; frequent esophageal dilatations over 7 years resulting in 2nd esophageal reconstruction; only one additional dilatation required over next 2 years > 7 years
29 2000 Chiang 20 mo M CR 2032 20.0
(based on
 imprint code;
 author gives
23 mm)
lithium unk 3 days upper
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 weeks
30 2002 Chan 1 y M unk 23 unk unk 1 day upper
tracheoesophageal fistula closed spontaneously after 8 months conservative therapy dyspnea; stridor endoscopic removal from esophagus unk
31 2002 NBIH 12 mo M CR 2032 20.0 lithium digital
~2 days upper
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 M unk ~ 21 mm unk unk 10 days upper
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 M DL 2025 20.0 lithium unk 9 hours mid
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 M CR 2032 20 lithium ab belt
16.5 hours upper or
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 months
35 2002 NBIH 12 mo M CR 2032 20.0 lithium unk ~ 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 months
36 2003 Petri 12 mo M CR 2032 20 lithium unk 3-9 days in esophagus; passed spontaneously upper
 at thoracic
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 weeks
37 2003 NBIH 20 mo M CR 2025 20.0 lithium unk 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 dilatations for esophageal stricture required over next 7 months > 7 months
38 2003 NBIH 13 mo M unk unk lithium unk 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 anasotomosis site > 1 year
39 2004 Alkan 16 mo F CR 2032 20.0 lithium unk >= 3 days upper
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 weeks
40 2004 Lin 10 mo F unk 20 suspect lithium
 based on
personal digital
6 hours upper
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 F unk 22.0 MnO2 calculator 17 days upper
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 weeks post ingestion
42 2004 Okuyama 20 mo M unk 20 suspect lithium
 based on
unk 1 week upper
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 publications:
Bekhof (2004);
 Bekhof (2005)
6 week F G13 11.6 manganese dioxide
 or silver oxide
(2 batteries)
unk > 24 h upper
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 year
44 2004 NBIH 20 mo F CR 2032 20 lithium talking book
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 dilatations done several times over 7 months post ingestion > 7 months
45 2004 NBIH 2 y M CR 2032 20.0 lithium digital ear
8 hours upper
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 months
46 2004 NBIH 20 mo F CR 2016 20 lithium remote
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 year
47 2004 Stubberud &
9 mo F unk 20.0 lithium
 based on
 video game
 (child found
 battery on
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, moved into stomach and 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 months
48 2005 Bekhof (2005) 11 mo F unk unk unk unk 4 hours upper
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 M unk size of
 (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 M CR 2025 20 lithium unk ~ 16 hours upper
1/4 of
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
 based on
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 months
52 2006 NBIH 16 mo M CR 2025 20 lithium remote
12 hrs upper
severe circumferential burn; unable to swallow some solids for at least 15 months gagging and choking; productive cough; decreased O2 sat endoscopic removal 15 months
53 2007 Nagao 8 y M 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 M unk 22 lithium unk ~1 week upper
large  (2 cm diameter) tracheoesophageal fistula involving > 1/3 of tracheal posterior circumference for at least 4 tracheal rings   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 dilatations required >3 months
55 2007 Bernstein 11 mo F CR 2032 20.0 lithium unk 5 hours upper
 level of
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 M DL 2032 20 lithium Tamagotchi
 (toy pet);
 removed by
 older sibling
3 hours upper
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 months
57 2007 NBIH 2 y F CR 2032 20.0 lithium bicycle
10 days upper
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; dilatations required at 3 week intervals > 4 months
58 2007 NBIH 11 mo F CR 2032 20 lithium unk 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 M CR 2025 20.0 lithium TV remote
5 hours lower
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 weeks
60 2007 NBIH 14 mo M CR 2032 20 lithium computer 8 hours upper
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 months
61 2008 Grisel 3 y F unk ~20.0 lithium unk 12 hours upper
 at thoracic
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 F unk 20 lithium
digital ear
~4 days mid
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 unk ~4 days upper
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 M CR 2032 20 lithium keyless car
~ 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 months
65 2008 NBIH 12 mo F 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 months
66 2008 NBIH 3 y F CR 2032 20 lithium unk 4-5 days upper
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 weeks)
67 2008 NBIH 13 mo M CR 2032 20.0 lithium iHome
remote control
7 days upper
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 F CR 2025 20 lithium remote
 control for
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 months
69 2009 Hamilton &
9 mo F 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 mos
70 2009 Raboei 22 day F   11.6 unk toy > 18 hours upper
 (level of
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 feeds > 1 year
71 2009 NBIH 14 mo F CR2025 20.0 lithium unk 9 hours upper
 (level of
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 months
72 2009 NBIH 23 mo F CR 2032 20 lithium watch 8.5-9 hours upper
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 F 2032 20.0 lithium bathroom
> 6 weeks upper
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 years (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 yo M CR 2025 20.0 lithium battery
3.5 hours proximal
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 weeks
75 2010 Tan & Gill
14 mo F CR 2032 20.0 lithium unk 4 weeks (conflicting histories of symptom onset) mid
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 F CR 2032 20.0 lithium automobile
 key fob
2 days battery at
 cricopharyngeal level in
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 months still on tube feedings; follow-up ongoing
77 2010 NBIH 17 mo M CR 2025 20.0 lithium remote
6 hours proximal
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 months still on tube feedings; follow-up ongoing
78 2010 NBIH 16 mo F CR 20?? 20.0 lithium battery
6 days proximal
just below
 negative pole
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 months post removal
79 2010 NBIH 11 mo F CR ???? 20.0 lithium unk 3 days mid
severe esophageal damage requiring surgical resection of portion of esophagus; perforated esophagus; severe, recurring esophageal strictures requiring stent (failed) then mitomycin C vomiting;
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 M CR2025 20.0 lithium battery
unknown unknown 2 "holes" in esophagus; subsequent scarring requiring 6-7 dilatations unknown endoscopic removal of battery; 6-7 dilatations unknown
81 2010 NBIH;
12 mo M 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 unknown
82 2010 NBIH 2 y M unk 20 mm lithium loose 18-19 hours proximal
just below
 negative pole
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 unknown
83 2010 Biswas 15 mo M unk 20 mm lithium unk ≥ 6 days upper
 just below
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 months
84 2010 Kimball 9 mo F unk 20 mm lithium unk 30 days upper
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 unknown
85 2010 Kimball 13 mo M unk unk lithium unk  7 days upper
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 unknown
86 2010 NBIH 18 mo M unk >=20 mm unk DVD remote 2 weeks-2 months proximal
 esophagus -
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 years
87 2010 Parray 4.5 y F BR 2330 23 mm lithium unk > 24 h upper
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 U unk unk unk unk unknown thoracic
esophageal perforation healed after 24 days esophageal rest (NPO) unknown unknown unknown
89 2010 NBIH
(this case is
 duplicated on
 Fatal Cases
list - case 32;
 child died
 nearly 2 years
 and 10 months
 after ingestion)
10 mo F unk 20.0 lithium unk > 8 hours cervical
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 unknown
90 2011 NBIH 9 yo M unk
20.0 lithium unk ≥4 days (based on symptom onset since ingestion not witnessed and denied by child) mid
just above
level of
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 F unk unk unk unk ~11-12 weeks upper
 at thoracic
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 report (case occurred in 2005) NBIH 2 yo M unk unk unk unk suspected 8-12 months based on symptom duration mid
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 unknown
93 2011 NBIH 3 yo M unk unk unk unk ~1 day mid
"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 unknown
94 2011 NBIH 6 yo F 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 months
95 2011 NBIH 15 mo M unk 20.0 lithium car key fob 5-14 days mid
level on
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 unknown
96 2011 NBIH 12 mo M 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 months
97 2011 NBIH unk M unk unk unk unk unknown esophagus tracheoesophageal fistula dyspnea, vomiting, choking; respiratory arrest 2 days after battery removal but was resuscitated endoscopic battery removal unknown; > 1 month
98 2011 NBIH 15 mo M unk 20.0 lithium remote
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 unknown
99 2011 NBIH 14 mo M unk 20.0 unk unk 4 hours upper
 (in neck);
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 months
100 2011 Spiers and
9 mo M CR 2032 20.0 lithium guitar tuner 14 hours distal
just above
 gastroesophageal junction;
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. unknown; > 5 months
101 2011 Wills
to remove
2 yo F unk unk unk flashlight days mid or
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 unknown
102 2011 NBIH 3 yo F unk 20.0 lithium unk > 2 days mid
tracheoesophageal fistula initial cough and fever; anorexia; lethargy; unwitnessed ingestion 2 surgical procedures; feeding tube; 3 weeks in ICU > 4 months
103 2011 Jarugula 5 mo M unk <12.4 mm
 on x-ray)
unk unk ~24 hours upper
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 24h; 2 weeks after removal developed noisy breathing and feeding problems endoscopic battery removal; antibiotics; gastrostomy tube feeding; external spinal brace; repeated esophageal dilatation unknown
104 2011 Jarugula 1 yo M unk <24.6 mm
 on x-ray)
unk unk 24 hours upper
esophageal necrosis 2-3 cm below cricopharynx; 3 cm tracheoesophageal fistula (evident on day 7) unknown endoscopic removal; defunctioning esophagostomy; gastrostomy tube feedings unknown
105 2011 Yalcin 2 mo F unk unk unk unk unk proximal
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 years
106 2011 Yalcin 18 mo F unk unk unk unk unk proximal
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 unknown
107 2011 Yalcin 5 mo F unk unk unk unk unk proximal
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 unknown
108 2011 Wu 9 yo F unk 20.0 lithium unk 6 hours distal
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 F unk 21.0 lithium unk 3 days upper
tracheoesophageal fistula cough endoscopic battery removal associated with ventilatory compromise; surgical repair of tracheoesophageal fistula unknown
110 2012 (occurred in 2010) Patel;
15 mo M CR 203? ≥ 20.0 lithium watch < 6 hours upper
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 years
111 2012 NBIH 19 mo F CR 2032 20.0 lithium unk possibly 10 days upper
esophageal microperforation; abscess; spondylodiscitis; osteomyelitis; prevertebral cellulitis (C7-T2 involved) cough x 10 days prior to presentation; trouble swallowing; fever; choking on food; neck pain developed 1 month after battery removal endoscopic battery removal; readmitted for IV antibiotics unknown
112 2012


Harjai 1 yo M unk 15 mm lithium toy
20 days upper
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 unknown
113 2012 NBIH 6 yo F CR 2032 20.0 lithium unk 3 days upper
circumferential burn; esophageal stricture dysphagia; stridor after removal endoscopic battery removal; unknown if dilation required a few weeks


114 2012 NBIH 2 yo F unk 20.0 lithium
 (2 batteries)
unknown upper
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 unknown
115 2012 NBIH 3 yo F CR 2025 20.0 lithium DVD remote 12 hours distal
esophageal narrowing on imaging with no apparent impact on eating abdominal, throat and shoulder pain; lethargy endoscopic removal of battery unknown
116 2012 Soccorso 3 yo M unk 20.0 lithium unknown 20 hours distal
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 unknown
117 2012 NBIH 13 mo M unk unknown unknown remote
 control for
(day of
tracheal damage; severe burns dyspnea; pain; coughing tracheostomy required; feeding tube; multiple surgical procedures and hospitalizations unknown
118 2012 NBIH 2 yo F CR 2032 20.0 lithium night light
 to crib
5 hours mid
esophageal perforation (healed spontaneously); circumferential necrosis chest pain endoscopic removal of battery; esophageal dilation 2-3 weeks
119 2013 NBIH 23 mo F unk 20.0 lithium unknown unknown (11 hours to 3 days) proximal
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 months
120 2013 Panella
(patient D)
8 mo M unk 20.0 lithium
 based on
unknown > 72 hours proximal
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 unknown
121 2013 Panella
(patient E)
34 mo M unk 20.0 lithium
 based on
unknown 24 hours proximal
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 months
122 2012 Simonin 16 mo M CR 2032 20.0 lithium remote
48 hours proximal
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 unknown (sent home on enteral feeding on day 19)
123 2012 Malik 10 mo M unk ~ 20 mm lithium unknown unknown mid
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 years
124 2013 Russell 15 mo M CR 2032 20.0 lithium for baby
left loose
6 hours mid
 (at level
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 Eshaghi 10 mo M unk ≥ 20.0 lithium unknown > 5 days upper
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 unknown
126 2013 NBIH 3 yo M CR 2025 20 mm lithium unknown 6-7 hours mid
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 months
127 2013 NBIH 7 days M AG 13 (2 batteries) 11.6 mm MnO2 lighted
by sib
unknown 2 batteries
 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 unknown
128 2013 Media &
18 mo F unknown unk unk unknown many days esophagus esophageal
fever, lethargy, coma, hoarse, cough endoscopic removal from esophagus; G-tube feedings unknown
129 2014 Hand 10 mo M unknown unk unk unknown 18 hours mid-upper
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 yo F unknown 20-23 mm lithium unknown 5 days mid
 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 unknown
131 2014 Pandey
3 yo F unknown 22 mm lithium unknown unknown upper or mid-
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 unknown
132 2014 Ruhl 17 mo M unknown unknown lithium unknown ~ 4 months cervical
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 unknown
133 2014 Jump 28 mo F unknown 20 mm lithium unknown ≥ 6 days upper
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 months
134 2014 Liao
11 mo F unknown unknown unk unknown 7 days mid
tracheoesophageal fistula dysphagia; fever; cough 35 day hospitalization; feeding tube; closed spontaneously after 4 months  
135 2014 Liao
3 yo F unknown unknown unk unknown 4 days esophagus tracheoesophageal fistula unknown 28 day hospitalization; feeding tube; antibiotics; fistula closed spontaneously  
136 2014 Liao
3 yo F unknown unknown unk unknown 5 days esophagus tracheoesophageal fistula unknown 21 day hospitalization; feeding tube; antibiotics; fistula closed spontaneously  
137 2014 NBIH 16 mo F unknown 20 mm lithium toy 10 hours upper
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 F unknown unknown unk unknown ≥ 7 days esophagus esophageal
unknown surgical closure; gastrostomy tube feeding; chest tube drainage; antibiotics x 28 days; 36-day hospitalization  
139 2013 NBIH 2 yo M unknown unknown lithium key fob unknown 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 M CR 2032 20 mm lithium unknown ~ 5 hours upper
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 M CR 2016 20 mm lithium book light ~ 15 hours upper
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 M unknown 20 mm lithium remote
3-30 days mid
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 M unknown > 20 mm lithium unknown ~ 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 yo F 2025 20 mm lithium video
11.5 hours upper
circumferential burn with necrosis; esophageal narrowing and some difficulty swallowing refusing food; pain; difficulty swallowing endoscopic removal  
145 2014 NBIH 10 mo M unknown 20 mm lithium keychain < 24 hours upper
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 Tabari 9 mo M unknown 5 mm unknown unknown ≥ 5 days proximal
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 Tabari 2.5 yo M unknown unknown unknown unknown ≥ 8 months distal
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 Tabari 2 yo F unknown unknown unknown unknown ≥ 8 days unknown tracheoesophageal fistula presented with dysphagia and choking x 8 days; fever developed post removal thoracotomy to repair tracheoesophageal fistula  
149 2011 Tabari 3 yo F unknown unknown unknown unknown ~ 1.5 months upper
tracheoesophageal fistula presented with cough, dyspnea, dysphagia and vomiting Tracheoesophageal fistula repaired through neck incision  
150 2014 Fuentes 7 yo F unknown 20 mm lithium unknown 6 hours upper
esophageal stenosis initial sialorrhea and vomiting endoscopic removal of battery; balloon dilatation x 4 beginning 4 weeks post ingestion  
151 2014 Fuentes 2 yo M unknown 20 mm lithium unknown a few hours upper
esophageal stenosis vomiting endoscopic removal of battery; 3 cm burn; esophageal dilatation required (once)  
152 2014 Zapf 20 mo F 2032 20 mm lithium unknown 7 hours upper
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 yo F unknown 20 mm lithium unknown 6 months mid
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 yo M unknown 20 mm lithium bathroom
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 Health Magazine;
Fairfax Media Digital;
Daily Mail Australia
8 mo M unknown unknown lithium unknown ~4 days upper
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 yo F unknown ≥ 20 mm lithium unknown 36 hours upper
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 certival esophagostomy and feeding gastrostomy; esophageal continuity was re=estalished 3 months later  
157 2015 Peters 4.5 yo U unknown unknown unknown unknown ~6 months thoracic
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 unknown
158 2013 Hall 6 weeks M unknown unknown unknown unknown unknown upper
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 yo U unknown unknown unknown unknown unknown upper
fistula; left vocal cord paralysis
unknown cervical repair of tracheosphageal fistula  
160 2014 Plumb 3 yo M unknown unknown unknown unknown ~24 hours mid
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, deveelopmental 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 M unknown 20 mm lithium unknown > 1 month mid
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 M 2025 20 mm lithium unknown ≥ 3 days mid esophagus mediastinitis unknown difficult removal due to granulation tissue; prolonged TPN  
163 2014 Kieu 14 mo M 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) upesented 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 F unknown 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 18 mo F unknown ~20 mm unknown 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 11 mo F unknown unknown unknown kitchen scale 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 months
167 2015 Smith 4 mo M unknown 11.6 unknown unknown > 155 hours upper esophagus corrosion of spine; 3 vertebrae damaged and collapsed; battery mistaken for shirt button on xray 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)  


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