Article Figures & Data
Figures
- Figure 1.
A. This supine anteroposterior view of the abdomen shows 2 cylindrical structures superimposing the right upper quadrant, likely in the gastric antrum (hospitalization day 1, prior to esophagogastroduodenoscopy [EGD]). B. Endoscopic image in retroflexion reveals an ingested battery in the gastric fundus. C. A cylindrical structure superimposing the mid lower abdomen represents the remaining ingested battery (hospitalization day 1, after EGD).
- Figure 2.
Supine anteroposterior views of the abdomen demonstrate the single ingested cylindrical structure advancing through the gastrointestinal tract (hospitalization days 2, 3, 4, 5, 6, and 7, respectively). A. Within the right upper quadrant and either in the distal ileum or proximal colon. B. Within the region of the ascending colon. C. Within the region of the ascending colon. D. Within the left mid abdomen and in the region of the descending colon. E. Within the region of the sigmoid colon. F. Projecting over the pelvis in the region of the rectum.
Tables
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.
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