G366(P) The presentation of an oesophageal button battery is a paediatric emergency

AimsDamage related to button battery ingestion is well recognised; tissues act as a conductor between negative and positive poles of the battery, producing sodium hydroxide and mucosal burns. Urgent removal is recommended but severe consequences of oesophageal lodgement are less well-recognised. We describe 8 cases of oesophageal button battery ingestion, highlighting importance of the oesophageal button battery as a paediatric emergency. Damage occurs within 1–2 hours of ingestion; delays before removal can be life-threatening.MethodsWe reviewed 8 cases of oesophageal button batteries over a 3 year period, noting time from ingestion to removal and the associated morbidities, from minor oesophageal injury to complex, tracheal and oesophageal surgery for perforation and erosion.ResultsAbstract G366 Table 1DemographiesIngestion to removalMorbidityFollow up5y,F3 hoursOesophageal mucosal injury.Outpatient clinic.17m, F3 hoursMediastinitis and tracheal- oesophageal fistula.Nasogastric feeds, surveillance endoscopies.23m, M4 hoursOesophageal mucosal injury.Oesophageal dilatations, outpatient review.13m, F5-7 hoursOesphageal mucosal injury.Oesophageal dilatations.2y,F7 daysTwo tracheal repairs, oesophagectomy.Tracheal stenting, oesophageal replacement surgery.2y, F7 daysAcquired tracheal-oesophageal fistula, oesophageal stricture, tracheal stenosis, required 2 tracheal repairs.Dilatations of trachea and oesophagus.2y, M5 monthsOesophageal resection and oesophageal atresia.Oesophageal dilatations.3.5y, FEmbedded batteryBattery removed from oesophageal pouch, oesophageal atresia.Oesophageal dilatations, possible pouch surgery.ConclusionsIngested button batteries lodged in the oesophagus can cause tissue injury in under 2 hours. Common sites for lodgement are the thoracic inlet, aortic arch, right main bronchus and gastro-oesophageal junction. Further damage occurs as a result of residual battery charge and time of contact between the battery and mucosal surfaces. Mortality is described due to aorto- oesophageal fistula. It is imperative batteries are removed immediately irrespective of anaesthetic starvation times and that oesophageal battery ingestion is highlighted as a paediatric emergency. There is no national guideline for the management of these children in the UK. Interventions must focus on increasing awareness of the dangers of button battery ingestion.