# Button Battery Ingestion — GCMD Library living collection

Everything in the library about button battery ingestion — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 45 cited statements

## Episodes
### Surgical Management
- [QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088) — video · 8:10 · [machine version](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088.md)

### Evidence & Research
- [Pediatric button battery ingestion: A single center experience and risk score to predict severe outcomes](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630) — video · [machine version](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630.md)
- [Ingestión de pila boton en pediatría: Experiencia de un centro y score de riesgo para predecir resultados](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631) — video · [machine version](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631.md)
- [Journal of pediatric surgery Article Review: April 2023, IPEG issue](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959) — podcast · 13:22 · [machine version](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959.md)

### Case-Based Learning
- [Button Battery Ingestion](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300) — video · 14:28 · [machine version](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300.md)

## Chapters
- [0:01](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1) Case presentation and initial management of button battery ingestion (Ep 1)
- [2:33](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=153) Complications and follow-up management controversies (Ep 1)
- [4:41](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281) Epidemiology, pathophysiology, and vascular complications (Ep 1)
- [8:47](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527) Management of batteries in the stomach and esophageal injury assessment (Ep 1)
- [9:56](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=596) Post-removal surveillance and management of identified injuries (Ep 1)
- [13:09](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=789) Emerging mitigation strategies and operational improvements (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630?t=0) Risk Score for Button Battery Ingestion Outcomes (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0) Introduction and Study Overview (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=0) Introduction and podcast overview (Ep 4)
- [0:48](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=48) Titanic Index for pectus excavatum measurement (Ep 4)
- [4:43](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=283) Button battery ingestion risk factors (Ep 4)
- [7:53](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=473) Laparoscopic versus open choledochal cyst resection (Ep 4)
- [11:29](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=689) Summary and closing announcements (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=0) Introduction to Quad Conference and Topic Overview (Ep 5)
- [0:41](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=41) Button Battery Ingestion Epidemiology and High-Risk Criteria (Ep 5)
- [2:05](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=125) Complications and Sentinel Bleeds (Ep 5)
- [3:05](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=185) Decision Algorithm for Management (Ep 5)
- [4:10](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=250) Case Example: Aortic Pseudoaneurysm Repair (Ep 5)
- [4:43](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=283) Complex Airway Reconstruction and ECMO Use (Ep 5)
- [6:10](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=370) Caustic Ingestion Management (Ep 5)
- [7:09](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=429) Summary and Key Takeaways (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- There are 3 locations in the esophagus where button batteries tend to get stuck: the upper esophageal sphincter, behind the aortic arch, and at the lower esophageal sphincter. — Aaron Garrison (clinical) [Ep 5 · 1:06](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=66)
- High-risk criteria include younger patients with smaller esophagus. — Aaron Garrison (clinical) [Ep 5 · 1:33](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=93)
- Longer duration that the battery has been in the esophagus is associated with worse outcomes. — Aaron Garrison (clinical) [Ep 5 · 1:43](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=103)
- If a patient has had a battery removed and presents later with a bleed, that is an emergency that needs to be taken seriously and requires a plan. — Aaron Garrison (clinical) [Ep 5 · 1:52](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=112)
- Almost 25% of patients in the Colorado series died. — Aaron Garrison (epidemiological) [Ep 5 · 2:22](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=142)
- Two of the fatalities in the Colorado series presented with the button batteries already in the stomach. — Aaron Garrison (epidemiological) [Ep 5 · 2:22](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=142)
- Any small communication between the esophagus and the aorta can be potentially life-threatening. — Aaron Garrison (clinical) [Ep 5 · 2:41](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=161)
- Aortoesophageal fistulas do not always happen in the hospital, so having a high index of suspicion and a plan for what to do once the battery is removed is helpful. — Aaron Garrison (clinical) [Ep 5 · 2:55](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=175)
- For sick patients with esophageal foreign bodies and active bleeding or clinical instability, it is recommended to have GI surgery and CT surgery available for the procedure. — Aaron Garrison (guideline) [Ep 5 · 3:26](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=206)
- If imaging shows injury close to the aorta, continue NPO and antibiotics and repeat MRI in 5 to 7 days to assess the trajectory of inflammation. — Aaron Garrison (guideline) [Ep 5 · 3:47](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=227)
- For high-risk patients (less than 5 years old, larger battery size), endoscopic evaluation of the esophagus is recommended because the duration of battery presence higher up than the stomach is unknown. — Aaron Garrison (guideline) [Ep 5 · 4:30](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=270)
- The need for ECMO or cardiopulmonary bypass depends on the location of the fistula and whether you can intubate past the injury enough to ventilate during the case. — Aaron Garrison (clinical) [Ep 5 · 4:43](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=283)
- If the fistula is near the carina, complex airway reconstruction will be needed and adequate ventilation during the case will not be possible. — Aaron Garrison (clinical) [Ep 5 · 4:59](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=299)
- In one case with a large tracheoesophageal fistula, the patient was placed on ECMO because they were unable to adequately ventilate. — Aaron Garrison (clinical) [Ep 5 · 5:21](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=321)
- In the Cincinnati Children's case, an interposition graft was performed by removing a segment of trachea and using that trachea as the front wall of the esophagus. — Aaron Garrison (clinical) [Ep 5 · 5:45](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=345)
- The airway may take priority in caustic ingestion cases, and patients can present in extremis or with an allergic-reaction-like presentation. — Aaron Garrison (clinical) [Ep 5 · 6:31](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=391)
- For esophageal perforation, the approach is to maintain the same exposure, debride to viable tissue, achieve layered closure with coverage, and if possible use a muscle flap for coverage. — Aaron Garrison (clinical) [Ep 5 · 6:56](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=416)
- If the perforation is too big, drain it to allow for delayed repair. — Aaron Garrison (clinical) [Ep 5 · 7:09](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=429)
- The Titanic Index measures the percentage of sternum that lies under the anterior costal line in pectus excavatum patients. — Luzia Toselli (clinical) [Ep 4 · 2:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=120)
- A Titanic Index cutoff of 66.5% predicts need for more than two bars with sensitivity of 93% and specificity of 92%. — Luzia Toselli (clinical) [Ep 4 · 3:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=180)
- The study included 78 pectus excavatum patients between 2020 and 2022, with 47% receiving two bars and 53% receiving more than two bars. — Luzia Toselli (epidemiological) [Ep 4 · 2:30](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=150)
- Time to button battery removal was not a significant predictor of severe outcomes in the Boston series. — Farokh Demeri (clinical) [Ep 4 · 7:24](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=444)
- The national database study included 577 pediatric choledochal cyst patients aged 0-21 years from 2016 to 2018, with 28% undergoing laparoscopic and 72% open resection. — Chad Thorson (epidemiological) [Ep 4 · 8:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534)
- Most open choledochal cyst procedures were hepaticojejunostomy while most laparoscopic procedures were hepaticoduodenostomy. — Chad Thorson (clinical) [Ep 4 · 9:27](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=567)
- Patients receiving open choledochal cyst operations had inferior outcomes including longer length of stay, higher cost, increased TPN use, and more central line requirements. — Chad Thorson (clinical) [Ep 4 · 9:27](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=567)
- Laparoscopic biliary anastomosis for choledochal cysts has a learning curve and is not recommended for early career surgeons without assistance. (opinion) [Ep 4 · 10:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=654)
- The Titanic Index is useful in clinical practice for preoperative planning of pectus excavatum repair. — Luzia Toselli (opinion) [Ep 4 · 4:25](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=265)
- Button battery ingestions are becoming more frequent, with national data showing increasing numbers of emergency department visits. — Dan (epidemiological) [Ep 1 · 0:01](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1)
- Button batteries are ubiquitous in greeting cards, remotes, and similar devices. — Dan (clinical) [Ep 1 · 0:50](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=50)
- A ring around the edge of a circular object on X-ray indicates it is a button battery, not a quarter. — Dan (clinical) [Ep 1 · 1:30](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=90)
- Foley catheter technique may work for button battery removal when operating room access is delayed and symptom duration is short. — Dan (clinical) [Ep 1 · 2:10](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=130)
- NASPGHAN and the GI group developed guidelines for button battery management with zero input from surgeons. — Mark (guideline) [Ep 1 · 3:44](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=224)
- Guidelines mandate serial MRIs for button battery cases due to concern for vascular injury. — Mark (guideline) [Ep 1 · 4:10](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=250)
- 20-25 millimeter batteries are lithium batteries that tend to be 3 volt rather than 1.5 volt. — Dan (clinical) [Ep 1 · 5:30](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=330)
- The pathophysiology is caustic injury from hydroxide ions that rapidly raise tissue pH, not mechanical erosion or electricity. — Dan (clinical) [Ep 1 · 5:45](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=345)
- Complications include esophageal perforation, stricture, tracheoesophageal fistula, and vocal cord paralysis not associated with perforation. — Dan (clinical) [Ep 1 · 6:10](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=370)
- Using trauma one system activation reduced time from door to OR from 1.5 hours to less than 30 minutes. (clinical) [Ep 1 · 8:47](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527)
- For minor mucosal injury on endoscopy, symptomatic follow-up without intervention is appropriate. — Dan (opinion) [Ep 1 · 10:24](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=624)
- For circumferential erosions that look bad, re-scoping to look for stricture formation is recommended. — Dan (opinion) [Ep 1 · 10:43](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=643)
- If patients become symptomatic after injury, esophagram can assess for narrowing or stricture. — Dan (clinical) [Ep 1 · 10:54](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=654)
- Endoscopy advantage over esophagram is ability to reassess appearance and dilate if needed. — Dan (clinical) [Ep 1 · 11:32](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=692)
- If already performing endoscopy and capable of removing battery from stomach, removal is advocated. — Dan (opinion) [Ep 1 · 12:27](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=747)
- 20-25 millimeter batteries are the ones of most concern. (clinical) [Ep 1 · 13:01](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=781)
- There is evolving work in animal models using 0.25% acetic acid applied to the area of injury to neutralize it. (clinical) [Ep 1 · 13:34](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=814)
- Acetic acid for neutralization is not something off the shelf and requires pharmacy coordination. (clinical) [Ep 1 · 13:58](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=838)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A 1992 study reviewed more than 2000 cases of button battery ingestion in children and found no deaths. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 0:41](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=41)
- Recent studies have found a sevenfold increase in fatalities following button battery ingestions. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 0:52](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=52)
- The increase in fatalities is because of the change to a 20-volt lithium cell which causes coagulative necrosis. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 0:59](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=59)
- When a button battery sits in one of these positions, it causes transmural injury and will make a fistula between the esophagus and adjacent structures including trachea, blood vessels, or vocal cords. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 1:14](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=74)
- A larger battery over 20 millimeters or greater is riskier. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 1:39](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=99)
- A battery behind the aortic arch is more concerning. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 1:49](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=109)
- In a Colorado study of 13 patients with high severity button battery injuries, 30% had esophageal perforation. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 2:05](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=125)
- In the Colorado study, 23% of patients developed stricture. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 2:14](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=134)
- Some patients in the Colorado study required G-tube placement and stayed in the hospital for nearly 2 weeks. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 2:16](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=136)
- Sentinel bleeds can be the first sign of aortoenteric fistulas. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 2:32](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=152)
- Some aortoesophageal fistulas showed up over 2 weeks after the batteries were removed. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 2:50](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=170)
- Imaging beforehand with a CTA to assess inflammation and proximity to the aorta is helpful. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 3:39](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=219)
- If there is any bleeding or concern for sentinel bleed, have a plan with interventional radiology, cardiology, or anyone who can help in that situation. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 3:59](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=239)
- In one case report with a pseudoaneurysm from the arch of the aorta, repair was done with a staged approach: sternotomy on bypass to fix the aorta with a graft, followed by flap repair of the esophagus. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 4:10](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=250)
- Button batteries are ingested more than 3500 times per year in the United States. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 6:10](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=370)
- Caustic ingestion is most common in young children between 1 and 3 years of age. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 6:20](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=380)
- Most caustic ingestions by children are accidental and the amounts ingested tend to be small. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 6:25](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=385)
- Acidic substances that are spit back up rather than swallowed can cause severe injury to the epiglottis. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 6:43](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=403)
- Smaller children, bigger batteries, and longer ingestion time pose greater risk. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 7:20](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=440)
- Do not be reassured by a battery in the stomach, as injuries can progress even after battery removal. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 7:25](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=445)
- Having an imaging plan to be proactive about finding transmural and worsening inflammation toward vessels is important. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 7:31](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=451)
- For caustic ingestions, be patient; small perforations can heal and be managed conservatively. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 7:39](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=459)
- If strictures develop after caustic ingestion, either dilation or surgery may be necessary. — Em Gootee summarizes what Dr. Aaron Garrison said [Ep 5 · 7:43](https://origin-library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-gar-8088?t=463)
- The Titanic Index provides an objective way to determine bar number rather than guessing based on eyeballing or age. — Ellen Encisco summarizing the discussion [Ep 4 · 3:59](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=239)
- Severe outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, or esophageal stricture development. — Ellen Encisco summarizing the discussion [Ep 4 · 5:36](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=336)
- The Boston Children's study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes. — Ellen Encisco summarizing the discussion [Ep 4 · 6:05](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=365)
- Three predictive factors for severe button battery outcomes are: battery in esophagus at presentation, battery size ≥2cm, and presence of any symptoms. — Ellen Encisco summarizing the discussion [Ep 4 · 6:20](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=380)
- There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types. — Mark Wulkan summarizing the discussion [Ep 4 · 10:32](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=632)
- The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed. — Mark Wulkan summarizing the discussion [Ep 4 · 6:33](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=393)
- The number of ED visits for button battery ingestion has doubled according to Colorado study data. — Dan summarizing the discussion [Ep 1 · 4:41](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281)
- The rate of significant complications from button batteries has increased almost sevenfold. — Dan summarizing the discussion [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=300)
- 90% of serious outcomes occur with 20-25 millimeter batteries. — Dan summarizing the discussion [Ep 1 · 5:15](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=315)
- Aortoenteric fistula is the most common cause of mortality in the national data bank, accounting for 46% of mortalities. — Dan summarizing the discussion [Ep 1 · 6:35](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=395)
- Another 29% of mortalities involved some sort of vascular compromise. — Dan summarizing the discussion [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=420)
- Aortoenteric fistula can occur up to 2 weeks post-removal of the battery. — Dan summarizing the discussion [Ep 1 · 7:15](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=435)
- Authors of the Colorado paper recommend MRI after battery removal to assess potential impact on surrounding vasculature. — Dan summarizing the discussion [Ep 1 · 7:35](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=455)
- Some authors advocate scoping patients even when battery is in the stomach because patients can have significant esophageal injuries with the battery having passed on. — Dan summarizing the discussion [Ep 1 · 9:28](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=568)
- Poison.gov recommendations say you do not need to scope if the battery is in the stomach. — Mark summarizing the discussion [Ep 1 · 9:56](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=596)
- There is GI literature about removing 20 millimeter batteries from stomach because they may not pass the ileocecal valve. — Dan summarizing the discussion [Ep 1 · 12:50](https://origin-library.globalcastmd.com/watch/button-battery-ingestion-2300?t=770)
- This is a retrospective study conducted at Boston Children's Hospital from 2008 to 2021 — Cecilia Gigena summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0)
- The study objective was to identify risk factors to create a score in patients who had ingested a button battery — Cecilia Gigena summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0)
- The study included 143 patients — Cecilia Gigena summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0)
- 24 patients had serious injuries from button battery ingestion — Cecilia Gigena summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0)
- Three risk factors predict serious injuries in button battery ingestion patients — Cecilia Gigena summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0)
- The first risk factor is the location of the button battery in the esophagus at the time of consultation — Cecilia Gigena summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0)
- The second risk factor is a button battery greater than 2 cm in diameter — Cecilia Gigena summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0)
- The third risk factor is the presence of symptoms at onset — Cecilia Gigena summarizing a resource [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/ingesti-n-de-pila-boton-en-pediatr-a-experiencia-de-un-centro-y-score-de-riesgo-6631?t=0)
- A retrospective study was conducted at Boston Children's Hospital from 2008 to 2021 examining button battery ingestion outcomes. — Cecilia Gigena summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630?t=0)
- The study analyzed 143 patients with button battery ingestion. — Cecilia Gigena summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630?t=0)
- 24 of 143 patients (16.8%) had severe outcomes after button battery ingestion. — Cecilia Gigena summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630?t=0)
- Esophageal location of the button battery is an independent predictor of severe outcomes. — Cecilia Gigena summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630?t=0)
- Button battery size larger than 2 cm is an independent predictor of severe outcomes. — Cecilia Gigena summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630?t=0)
- Presence of symptoms at presentation is an independent predictor of severe outcomes. — Cecilia Gigena summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630?t=0)
- The study proposes a risk score to predict severe outcomes in patients with button battery ingestion. — Cecilia Gigena summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/pediatric-button-battery-ingestion-a-single-center-experience-and-risk-score-to-6630?t=0)

## Common questions
### What do the experts recommend for Button Battery Ingestion?
For high-risk patients (age <5 years, larger battery size), endoscopic evaluation of the esophagus is recommended because the duration of battery presence higher up than the stomach is unknown. The Foley catheter technique may work for button battery removal when operating room access is delayed and symptom duration is short. Guidelines mandate serial MRIs for button battery cases due to concern for vascular injury. Risk stratification using specific criteria—battery location in the esophagus, battery size, and patient age—can identify severe outcomes and guide transfer decisions.

## Changelog
- Sep 25: 2 items added automatically
- Sep 17: 3 items added automatically

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