Potential problems:
(1) lodgment in the esophagus
(2) failure to leave the stomach
(3) release of strong alkali with mural necrosis and perforation
(4) release of contents with heavy metal or other chemical poisoning
First step: Take PA and lateral radiographs of the chest and abdomen to (a) confirm ingestion and (b) determine its location.
Second step: Determine the type and size of the battery.
If the battery is lodge in the esophagus:
(1) Urgent endoscopy to remove the battery.
(2) If a full thickness burn has occurred, perform bronchoscopy.
If the battery is in the stomach and the diameter is < 15 mm:
(1) Observe the patient.
If the battery is in the stomach and the diameter is >= 15 mm:
(1) Repeat an X-ray of the upper abdomen in 48 hours.
(2) If the battery is still in the stomach, perform endoscopy to remove the battery. If the battery has passed the pylorus, observe the patient.
If the battery is beyond the pylorus:
(1) Observe the patient
Additional guidance:
(1) If the battery contains mercury or other heavy metals, consider monitoring for heavy metal poisoning.
(2) Passage of the battery should be confirmed by examination of the stool. This may take several hours to days or even weeks.
(3) Cathartics may hasten transit.
(4) During the observation the patient should be evaluated for abdominal discomfort, pain, hematochezia (bloody stools), or signs of intestinal perforation.
(5) Signs of battery leakage may include radiographic evidence of fragmentation or discoloration of the stools.
