title: Imaging button battery ingestions and insertions in children: a 15-year single-center review.
abstract: BACKGROUND
  Recent studies have shown an increase in morbidity associated with button battery ingestions in children.
  
  
  OBJECTIVE
  To perform a comprehensive, imaging-focused review of all patients with confirmed button battery ingestions/insertions imaged at our institution in the last 15 years.
  
  
  METHODS
  Radiology reports from Jan. 1, 2000, to July 12, 2015, were searched for the terms "battery" and "batteries." Confirmed cases of battery ingestion/insertion for which images were available were reviewed. Cases were reviewed for imaging studies performed, imaging findings, patient demographics, clinical history and management. Two pediatric gastroenterologists reviewed endoscopic images and graded mucosal injuries in selected cases.
  
  
  RESULTS
  Two hundred seventy-six cases were reviewed. All patients were imaged with radiography, 19 with fluoroscopy (6.8%), and 4 with CT (1.4%). Batteries retained in the esophagus (n = 27, 9.8%) were larger in diameter on average than those that had passed distally (22.1 ± 3.3 mm vs. 13.7 ± 1.6 mm, P<0.0001). Battery diameter ≥20 mm was associated with esophageal impaction (P<0.0001) and higher grade esophageal injury (P<0.0001). Mean battery diameter was greater for patients with grade 1 or higher mucosal injury than for patients with no mucosal injury (22.1 ± 2.1 mm vs. 14.7 ± 4.5 mm, P<0.0001). Sixteen percent (4/25) of patients with grade ≥1 esophageal injury had batteries in the stomach on initial imaging. Five patients (1.8%) had serious clinical complications (e.g., esophageal perforation, tracheoesophageal fistula).
  
  
  CONCLUSIONS
  Button batteries >20mm in diameter warrant increased clinical scrutiny due to higher likelihood and severity of injury. Implementation of recent pediatric gastroenterology societal guidelines will likely lead to a substantial increase in the number of CT and MRI examinations.
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Pugmire
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Tom K
authors.initials: TK
authors.lastname: Lin
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Pentiuk
authors.affiliation: Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Department of Otolaryngology--Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: de Alarcon
authors.affiliation: Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Department of Otolaryngology--Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Hart
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. Andrew.Trout@cchmc.org.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Trout
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004435:Eating; D011211:Electric Power Supplies; D005260:Female; D005471:Fluoroscopy; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D014057:Tomography, X-Ray Computed
keywords: Button batteries; Children; Computed tomography; Esophagus; Foreign body; Gastrointestinal tract; Radiography