title: Management of button battery-induced hemorrhage in children.
abstract: OBJECTIVE
  Button battery ingestions are potentially life threatening for children. Catastrophic and fatal injuries can occur when the battery becomes lodged in the esophagus, where battery-induced injury can extend beyond the esophagus to the trachea or aorta. Increased production of larger, more powerful button batteries has coincided with more frequent reporting of fatal hemorrhage secondary to esophageal battery impaction, but no recommendations exist for the management of button battery-induced hemorrhage in children.
  
  
  METHODS
  We reviewed all of the reported pediatric fatalities due to button battery-associated hemorrhage. Our institution engaged subspecialists from a wide range of disciplines to develop an institutional plan for the management of complicated button battery ingestions.
  
  
  RESULTS
  Ten fatal cases of button battery-associated hemorrhage were identified. Seven of the 10 cases have occurred since 2004. Seventy percent of cases presented with a sentinel bleeding event. Fatal hemorrhage can occur up to 18 days after endoscopic removal of the battery. Guidelines for the management of button battery-associated hemorrhage were developed.
  
  
  CONCLUSIONS
  Pediatric care facilities must be prepared to act quickly and concertedly in the case of button battery-associated esophageal hemorrhage, which is most likely to present as a "sentinel bleed" in a toddler.
authors.affiliation: Department of Pediatrics, Section on Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado Denver School of Medicine, and Children's Hospital, Aurora, Colorado 80045, USA. Brumbaugh.david@tchden.org
authors.forename: David E
authors.initials: DE
authors.lastname: Brumbaugh
authors.forename: Steven B
authors.initials: SB
authors.lastname: Colson
authors.forename: John A
authors.initials: JA
authors.lastname: Sandoval
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Karrer
authors.forename: John F
authors.initials: JF
authors.lastname: Bealer
authors.forename: Toby
authors.initials: T
authors.lastname: Litovitz
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kramer
mesh_terms: D001011:Aorta / Q000293:injuries; D002675:Child, Preschool; D011211:Electric Power Supplies; D004935:Esophageal Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004937:Esophageal Fistula / Q000209:etiology; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic; D014132:Trachea / Q000293:injuries; D016157:Vascular Fistula / Q000209:etiology