the incidence of ingestion of button batteries has increased during the past several years , with the increase in the availability of these devices . more than 90% of swallowed batteries pass through the gastro - intestinal ( gi ) tract and do not cause a problem . the narrowest area within the gi tract is the esophagus ; therefore , it is the most common site of foreign body impaction . an esophageal foreign body may lodge in three distinct sites : the thoracic inlet , aortic arch area , and the gastro - esophageal ( ge ) junction . the most common sites of impaction are the thoracic inlet followed by the ge junction and the aortic arch . if a battery becomes impacted in the esophagus , it may penetrate the esophageal wall and cause a tracheo - esophageal fistula ( tef ) . thus early diagnosis and extraction of the battery flexible versus rigid endoscopy for removal of foreign body impaction in the esophagus is useful . the risk of development of tef increases after the ingestion and its symptoms include food aspiration , fever , cyanosis , mediastinitis , pneumonia , and respiratory distress . the first step in suspected foreign body ingestion is a chest x - ray . in case more than several hours have passed since ingestion , it is recommended to perform a radiographic contrast test to rule out perforation . in some circumstances an esophageal foreign body may cause a meditational mass , which can be diagnosed by chest x - ray . we reviewed the medical records of children admitted to mofid children s hospital due to disc battery ingestion from january 2006 to january 2010 . the diagnosis of disc battery ingestion was based upon history , clinical symptoms , and results of imaging studies . the clinical data reviewed included age , gender , clinical manifestation , imaging findings , disc battery location , time of ingestion , endoscopic results , and treatment . a total of 22 patients ( 11 males , 11 females ) were referred to our hospital due to disc battery ingestion , with a mean age of 4.3 years ( range : 9 months to 12 years ) . the mean duration of ingestion was 2.7 days ( 4 hours to 1.5 months ) . there were 19 patients with histories of disc battery ingestion . however , 3 cases were referred with the above symptoms , and the battery was accidentally found during radiological studies . these 3 patients presented with intractable cough , mild cyanosis and dyspnea 18 days ( 5 to 45 days ) after battery ingestion . all patients underwent chest x - ray examinations , and 17 cases received endoscopic studies . three patients ( 14% ) had esophageal battery impaction and 1 ( 4.7% ) had small bowl impaction . the locations of disc batteries in the esophagus was 62% in the upper third ( 13 cases ) , and 19% in the lower third ( 4 cases ) . the others were : 2 in the stomach ( 9.5% ) and 2 in the small bowl ( 9.5% ) . figure 1 demonstrates an ingested disc battery in the upper part of the esophagus in a patient . the duration of batteries lodged in the esophagus ranged from 1 to 45 days , those in the stomach were lodged from 1 to 4 days , and in the case of intestinal perforation it was 15 days . twelve patients with esophageal foreign bodies had their batteries removed successfully by endoscope within 3 to 5 hours of admission , but in 3 cases , batteries were removed later ( up to 24 hours ) . the mean duration of disc battery ingestion for complicated cases was 18 days , in uncomplicated cases it was 3 - 5 days , and in endoscopic cases the mean duration was 1 - 3 days . three cases , due to delayed admission and disc battery impaction after endoscopic removal developed tef ( figure 2 ) . one patient with a disc battery located in the stomach underwent laparotomy due to bowl perforation . after removal of the disc , resection and anastomosis was performed . in the other 6 patients , batteries spontaneously passed through their gi tracts within 5 days . among the patients who underwent endoscopic removal of the battery in the esophagus , all pathologically revealed mucosal erosion with necrosis the male - to - female ratio in young children is 1:1 , but in older children males are more commonly affected than females . foreign body ingestion is a potentially serious problem that peaks in children 6 months to 3 years of age . of foreign bodies ingested , 10%-20% fail to pass through the entire gi tract . any foreign body that remains in the tract may cause obstruction , perforation or hemorrhage , and fistula formation . disc batteries contain mercury , silver , zinc , manganese , lithium , sulfur oxide , copper , or steel as the components of the anode . the cathode also contains either sodium hydroxide or potassium hydroxide to facilitate the electrochemical reactions through electrolyte - soaked separation . the three most commonly involved battery systems are those with manganese dioxide , silver oxide , and mercuric oxide . the esophagus is a passive and inadaptable organ in which peristalsis may not be sufficient to pass large objects . for the same reason , perforation from a foreign body is more likely to occur in the esophagus than in the remainder of the tract . perforation of the esophagus is dangerous because it may lead to parapharyngeal or retropharyngeal abscess , with possible descending mediastinitis . therefore , the most common site of foreign body impaction is the esophagus ( 16 cases in our series ) . the most common site of impaction is in the thoracic inlet as evidenced by 13 disc batteries located in the upper third of the esophagus in our study , followed by the gi junction ( 4 cases ) and the aortic arch . esophageal foreign bodies can produce symptoms of dysphasia , refusal to eat , drooling , coughing , stridor , vomiting , gagging , or regurgitation . in our series the symptoms were cough , cyanosis , dysphasia , choking , and vomiting , however , many children with esophageal foreign bodies are asymptomatic . classically , partially obstructive laryngeal foreign bodies are oriented sagittally at the level of the vocal cords , while esophageal foreign bodies are oriented coronally . standard radiologic workup for suspected battery ingestion is the chest film , in both ap and lateral views , which we performed for all patients in the group . x - ray films have high availability , low cost , and high accuracy in outlining radiopaque objects . in the event of an impacted battery in the esophagus for more than several hours it is recommended to perform a radiographic contrast test to rule out perforation , but sometimes this may not be feasible because of technical difficulties and the risk of pulmonary aspiration . in these cases , disc battery ingestion have traditionally been feared in children as they could cause corrosive injury . a disc battery is removed endoscopically on an urgent basis if it is found to be in the esophagus ; we removed 15 cases endoscopically in our series . delayed diagnosis of an impacted battery is not uncommon , and may occasionally cause long - term complications , such as perforation or tef . the chances of perforation are very high after eight hours of retention at a specific site . thoracotomy and fistula repair is a routine approach , as we have performed for 3 patients . most cases of disc battery ingestion run uneventful courses , but some may be complicated . if the battery impacts in the esophagus , emergency endoscopic management is necessary , but once in the stomach it will usually pass through the gastrointestinal tract . this study was financially supported by the office of the vice chancellor for mofid children s hospital clinical research development center ( crdc ) .
backgroundthe purpose of this study was to evaluate the characteristics , management , and outcomes of disc battery ingestion in children.methodswe reviewed the medical records of children admitted to mofid children s hospital due to disc battery ingestion from january 2006 to january 2010 . 
 clear history , clinical symptoms and results of imaging studies revealed diagnosis of disc battery ingestion in suspected patients . 
 the clinical data reviewed included age , gender , clinical manifestation , radiologic findings , location of disc battery , duration of ingestion , endoscopic results and surgical treatment.resultswe found 22 cases ( 11 males and 11 females ) of disc battery ingestion with a mean age of 4.3 years ( range : 9 months to 12 years ) . 
 common symptoms were vomiting , cough , dysphagia , and dyspnea . 
 the mean duration of ingestion was 2.7 days ( 4 hours to 1.5 months ) . 
 a total of 19 patients had histories of disc battery ingestion , but three cases referred with the above symptoms , and the batteries were accidentally found by x - ray . 
 only three cases had batteries impacted in the esophagus . 
 twelve batteries were removed endoscopically , 6 batteries spontaneously passed through the gastrointestinal ( gi ) tract within 5 to 7 days , and 4 patients underwent surgery due to complications : 3 due to tracheo - esophageal fistula ( tef ) and 1 due to intestinal perforation . 
 there was no mortality in our study.conclusionmost cases of disc battery ingestion run uneventful courses , but some may be complicated . 
 if the battery lodges in the esophagus , emergency endoscopic management is necessary . 
 however , once in the stomach , it will usually pass through the gi tract .