Vascular Complications in Children Following Button Battery Ingestions: A Systematic Review

Context: Children presenting to health care facilities with button battery (BB) impaction.

Objectives: To describe characteristics of children with vascular complications after BB impaction, as well as associated outcomes.

Data sources: National Capital Poison Center registry and PubMed database from inception to December 2021.

Study selection: All reports describing children aged <18 years with vascular, esophageal, or airway complications after BB ingestion.

Data extraction: We extracted characteristics including date of publication, age and sex of child, battery type and size, duration and location of impaction, complications, subsequent interventions, and interval between battery removal and death.

Results: A total of 361 cases involved severe complications or death after BB ingestion (321 cases from the National Capital Poison Center registry database, 40 additional cases from PubMed). Nineteen percent (69 of 361) were fatal and 14% (51 of 361) involved vascular injuries. Three-quarters (75%) of vascular complications were aorto-esophageal fistulae and 82% of vascular injuries were not survivable. Fatal vascular cases had significantly longer median impaction time (96 hours versus 144 hours, P <.05) and a wider range of presenting features than survivors.

Limitations: The total number of cases with vascular complications was small, data reported varied between cases, and no data were available on overall exposure. Long-term morbidity data were not available for the survivors.

Conclusions: Prolonged BB impaction is a risk factor for vascular complications and death. A high index of suspicion is required for children representing with hematemesis after BB impaction, with prompt transfer to a tertiary center because vascular surgical intervention may offer a chance of survival.