Table.

Summary of Reported Cases of Patient Ingestion of Cylindrical Batteries

Case	Patient Age, years/Sex	Known Psychiatric Illness/Suicide Attempt	Interval Between Ingestion and Diagnosis	Number and Type of Batteries Ingested	History of Abdominal Surgery	Case Presentation, Course, and Outcome
Levine et al,¹⁰ 1984	31/Female	Yes/Yes	2 weeks	1 C cell	NR	• 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 1989	33/Male	Yes/Yes	6 hours	5 AAA	Laparotomy 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 1993	24/Female	Yes/Yes	24 hours	3 AA	Surgery 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 1999	20/Male	Yes/Yes	NR	1 alkaline cylindrical/2 alkaline cylindrical	NR	• 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 1999	Late teens/Male	Yes/NR	NR	2 alkaline cylindrical	NR	• Asymptomatic at presentation • Abdominal x-ray showed undamaged batteries beyond the pylorus; passed via rectum a week later
Hindley et al,¹³ 1999	Late 20s/Male	Yes/Yes	NR	2 alkaline	NR	• Asymptomatic at presentation • Abdominal x-ray showed batteries with damaged casings beyond the pylorus; passed via rectum within 2 weeks
Hindley et al,¹³ 1999	20s/Male	Yes/Yes	NR	2 alkaline	NR	• Asymptomatic at presentation • Abdominal x-ray showed batteries beyond the pylorus; passed via rectum within 2 weeks
Hindley et al,¹³ 1999	30s/Male	Yes/Yes	NR	4 alkaline	NR	• 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 2006	60/Male	NR/NR	NR	2 Duracell 3-volt	NR	• 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 2008	38/Male	No/No	6 years	2 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 2010	27/Female	Yes/Yes	2 batteries ingested 24 hours prior to presentation	6 AAA and 4 button	NR	• 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 2011	56/Male	Yes/NR	7 days	2 AA	NR	• 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 2012	36/Male	Yes/Yes	1 hour	6 AAA	NR	• Pseudoinfarction pattern on ECG • Batteries removed endoscopically; ST segment abnormality resolved
Malliwal and Bhattacharya,¹⁹ 2013	54/Male	Yes/NR	3 days	5 AA	Prior 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 2014	1/Female	NR/NR	26 hours	1 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 2015	31/Male	NR/Yes	2 hours	5 AAA and 2 AA	NR	• 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 2015	37/Male	NR/NR	7 hours	6 AA and 2 AAA	Emergent 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 2016	83/Female	No/Yes	25 minutes	3 AAA	NR	• 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 2017	17/Female	Yes/No	14 hours	2 AA and 1 AAA	Yes (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 2017	30/Female	Yes/No	1 hour	4 button and 2 AAA	NR	• 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.