Summary of Reported Cases of Patient Ingestion of Cylindrical Batteries

CasePatient Age, years/SexKnown Psychiatric Illness/Suicide AttemptInterval Between Ingestion and DiagnosisNumber and Type of Batteries IngestedHistory of Abdominal SurgeryCase Presentation, Course, and Outcome
Levine et al,10 198431/FemaleYes/Yes2 weeks1 C cellNR• Grand mal seizure at presentation • Battery in stomach with mild diffuse gastritis could not be retrieved endoscopically; retrieved by gastrostomy; showed marked corrosive changes and was beginning to open
• No further seizure activity; further workup for seizures unrevealing
Young and Lubitz,11 198933/MaleYes/Yes6 hours5 AAALaparotomy to remove razors ingested in a suicide attempt 7 years prior• Mild epigastric pain at presentation • Batteries arrested at the pyloric sphincter and removed with Dormia basket one at a time • Undamaged gastric mucosa
Kaplan and Totten,12 199324/FemaleYes/Yes24 hours3 AASurgery for previous cylindrical battery ingestion• Left upper quadrant pain at presentation • Endoscopic removal unsuccessful (patient agitated and uncooperative); patient declined surgery and released to psychiatric facility; follow-up 48 hours later showed 1 battery in the stomach and 2 batteries lodged at the IC valve with continued abdominal pain • Batteries uneventfully removed via cecotomy and gastrostomy
Hindley et al,13 199920/MaleYes/YesNR1 alkaline cylindrical/2 alkaline cylindricalNR• Immediately symptomatic with acute upper GI pain (patient bit casing prior to ingestion) • Emergent battery retrieval via laparotomy • After return to psychiatric facility, patient swallowed 2 batteries; repeat laparotomy for battery retrieval; course complicated by Clostridium difficile infection
Hindley et al,13 1999Late teens/MaleYes/NRNR2 alkaline cylindricalNR• Asymptomatic at presentation • Abdominal x-ray showed undamaged batteries beyond the pylorus; passed via rectum a week later
Hindley et al,13 1999Late 20s/MaleYes/YesNR2 alkalineNR• Asymptomatic at presentation • Abdominal x-ray showed batteries with damaged casings beyond the pylorus; passed via rectum within 2 weeks
Hindley et al,13 199920s/MaleYes/YesNR2 alkalineNR• Asymptomatic at presentation • Abdominal x-ray showed batteries beyond the pylorus; passed via rectum within 2 weeks
Hindley et al,13 199930s/MaleYes/YesNR4 alkalineNR• Abdominal x-ray showed all batteries beyond the pylorus • Three passed via rectum in 1-2 months; fourth remained in cecum after 3 months
Lim et al,14 200660/MaleNR/NRNR2 Duracell 3-voltNR• Ten-day history of nausea, vomiting, and epigastric pain • Abdominal x-ray showed 2 metallic bodies in the stomach at the proximal greater curvature • Multiple deep ulcers noted on endoscopy; both batteries retrieved by Roth Net via an overtube; visible leakage from the copper tops and destruction of the grommet seals and positive terminals
Lavon et al,15 200838/MaleNo/No6 years2 pairs of cylindrical (each pair wrapped in plastic)NR• Swallowed drug packets and 2 pairs of batteries to push drug packets down the GI tract; all drug packets and one pair of batteries expelled within several days; 6 years later, patient presented with intermittent diffuse abdominal discomfort and heartburn of several months • Abdominal x-ray showed radiopaque mass in the stomach; attempt to retrieve batteries with forceps failed because plastic began to tear and leakage was a concern; batteries removed laparoscopically; gastric biopsy revealed mild chronic inflammation • Postoperative course unremarkable; discharged 5 days later with resolution of presenting symptoms
Nielsen et al,16 201027/FemaleYes/Yes2 batteries ingested 24 hours prior to presentation6 AAA and 4 buttonNR• Decreased mental state (coingestion of mirtazapine) and stomach pain at presentation • All cylindrical and 2 button batteries discharged via rectum by day 3; CT showed 2 remaining batteries in the cecum and stomach • During EGD to retrieve stomach battery, small (mm size) erosions noted; retrieval unsuccessful; battery had passed the pylorus • Patient discharged and observed at psychiatric facility; no adverse outcomes reported
Ribakovs and Uzoigwe,17 201156/MaleYes/NR7 days2 AANR• Mild epigastric pain and vomiting progressed to debilitating global pain and refractory vomiting by day 7 • Physical examination revealed rigid abdomen with peritonitis; abdominal x-ray showed 2 batteries in the ascending colon; CT revealed 1 battery in the cecum proximal to fecal loading in ascending colon and the second battery extraluminal • Laparotomy showed 1 battery protruding through ascending colon at hepatic flexure; hemicolectomy performed • Pathology of resected colon showed second battery impacted in a diverticulum 30 mm distal to the IC valve; site of distal perforation revealed cell necrosis and serositis consistent with chemical injury rather than pressure effect
Chang et al,18 201236/MaleYes/Yes1 hour6 AAANR• Pseudoinfarction pattern on ECG • Batteries removed endoscopically; ST segment abnormality resolved
Malliwal and Bhattacharya,19 201354/MaleYes/NR3 days5 AAPrior suicide ingestions, one requiring laparotomy • Diffuse abdominal discomfort without clinical evidence of obstruction at presentation • Serial images tracked battery progression along the gut; by day 5 all batteries transited to the large bowel • All batteries passed via rectum
Cyrany et al,20 20141/FemaleNR/NR26 hours1 A23 NR• No symptoms at presentation • Battery extracted by endoscopy and polypectomy snare; two 10-15 mm ulcers on the front and back walls of the stomach; several small erosions in the greater curvature • Subsequent course uneventful
Hammad et al,21 201531/MaleNR/Yes2 hours5 AAA and 2 AANR• No symptoms at presentation • Abdominal series showed 7 cylindrical batteries • First EGD, 2 batteries visualized; retrieved by Roth Net; no mucosal damage • Next morning, patient had mild abdominal pain and mild epigastric tenderness • Second EGD in 12 hours, 3 batteries in the gastric body with 3 deep gastric ulcerations (2 in the antrum and 1 in the incisura) and multiple gastric erosions; superficial duodenal mucosal erosions; 1 battery beyond the ligament of Treitz; 4 batteries retrieved by Roth Net; seal of the batteries eroded with evident leakage of chemical contents • Final battery passed via rectum 3 days later
Dunphy et al,22 201537/MaleNR/NR7 hours6 AA and 2 AAAEmergent laparotomy 12 months earlier for retrieval of ingested batteries• Generalized midabdominal pain and self-inflicted laceration of left antecubital fossa (using the metal casing from one battery) at presentation • Batteries failed to pass with conservative management; patient developed small bowel obstruction • All batteries retrieved via laparotomy; superficial mucosal necrosis but viable mucosa otherwise; active leak of contents from 2 batteries observed
Kayıpmaz et al,23 201683/FemaleNo/Yes25 minutes3 AAANR• No symptoms at presentation • Batteries removed endoscopically by snare and overtube; piece of paper removed from duodenum; 3-4 cm distal esophageal laceration; edematous, erythematous, and stained with hematin gastric mucosa around the batteries; superficial ulcer • Patient/family refused further care and left AMA from ED
Tien and Tanwar,24 201717/FemaleYes/No14 hours2 AA and 1 AAAYes (removal of prior battery ingestion)• Abdominal pain at presentation • Abdominal x-ray showed 3 radiopaque structures (2 in epigastrium and 1 in right iliac fossa); urgent EGD removed 1 AA and 1 AAA batteries by Roth Net; gastric ulceration and gastritis; normal esophagus and duodenum • Remaining battery (in distal small bowel) monitored conservatively with laxatives and abdominal x-ray; 2 days later, x-ray suggested impaction at IC valve • Battery removed via ileocolonoscopy from the proximal right colon by Roth Net
Paparoupa and Bruns-Toepler,25 201730/FemaleYes/No1 hour4 button and 2 AAANR• No symptoms at presentation; patient violent in ED; administered sedatives and intubated • Urgent EGD removal of 2 button batteries from stomach • Colon preparation initiated;12 hours later, abdominal x-ray identified a cluster of batteries in right lower quadrant; followed by immediate colonoscopy; 4 batteries (2 button, 2 AAA) visualized in large bowel; • 3 removed with Dormia basket • Fourth battery (AAA) moved into small bowel and retrieved from terminal ileum with endoscopic loop
  • AMA, against medical advice; CT, computed tomography; ECG, electrocardiogram; ED, emergency department; EGD, esophagogastroduodenoscopy; GI, gastrointestinal; IC, ileocecol; NR, no record.