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| The Surgical Technologist | MAY 2016 210 D I S C B A T T E R Y I N G E S T I O N Every suspected case of battery ingestion, even in asymp- tomatic patients, requires immediate medical attention. While about 80% to 90% of ingested disc batteries in chil- dren will likely pass spontaneously though the entire gas- trointestinal (GI) tract without incident, batteries retained in the body can have detrimental effects. 3 Disc batteries can contain numerous heavy metallic salts such as lithium oxide, mercuric oxide, silver oxide and zinc oxide among others that can cause great damage to tissues. 4 They also contain concentrated solutions of harmful caustic alkaline fluids such as sodium hydroxide and potassium. 5 The three areas in the GI tract where batteries can meet resistance and become lodged are the esophagus, the stomach and the intestines, with the esophagus being the most common. 6 D I A G N O S I S Quicker interventions occur when button battery inges- tion is witnessed in children. However, in as many as 40% of cases, battery ingestion in infants and children is not witnessed. 3 Children are usually brought to the health- care facility because they start to experience symptoms. Symptoms can vary depending on the location of the bat- tery, the length of time that has passed since the battery was ingested and where the battery is lodged. Symptoms may include: sudden refusal to eat, drooling, decreased appetite, coughing, choking or gagging with eating or drinking, fussiness, stridor, wheezing, respiratory distress, chest pain, abdominal pain, abdominal distention, fever, vomiting, bloody stool and tachy- cardia, among others. 5 When foreign body ingestion is sus- pected, radiographic studies will need to be performed. Typically, these will be plain radiographs (X-rays). Both anteroposterior (AP) and lateral films will be needed to localize the foreign body. Lateral films will aid in determin- ing if a foreign body is in the esophagus or the trachea and may detail foreign bodies obscured by the overlying spine. 3 Coins and disc batteries can look similar on an X-ray, but there are certain characteristics that set them apart. Figure 2 (on page 212) shows the difference between a coin and disc battery on plain radiographs. Disc batteries can have a char- acteristic double-density shadow or “halo” on AP X-rays. Laterally, these batteries’ edges are rounded, and they some- times contain a step off junction at the positive and negative terminal. 8 These differences can help distinguish them from coins and buttons. Once battery ingestion is diagnosed, the physician must determine whether intervention is needed and what degree of urgency is merited. T H E E S O P H A G U S While batteries have the potential to cause damage in all areas, damage in the stomach and intestines is less likely. The majority of tissue damage occurs when the battery is lodged in the esophagus. 9 The reason batteries in the esoph- agus cause more damage is due to the different physiologic conditions in the esophagus as opposed to the stomach and intestines. When ingested, disc batteries discharge their current across tissue or liquid. When in the stomach and intestines, disc batteries discharge their current through the gastric fluid, generally without damaging the mucosa. In the esophagus, however, the battery is wedged into tissue. This causes the batteries to discharge their current through esophageal tissue and potentially cause burns. 4 Damage due Figure 1 Shown are the size of disc batteries in comparison with coins The reason batteries in the esophagus cause more damage is due to the different physiologic conditions in the esophagus as opposed to the stomach and intestines.