Esophageal Foreign Body — Button Battery MCQ — NEET PG Practice Question | NEETPGAI
Esophageal Foreign Body — Button Battery
medium
smile Pediatrics
A 22-month-old toddler presents to the ED 1.5 hours after witnessed ingestion of a 20 mm lithium button battery (CR2032) from a TV remote. He is drooling and refusing oral intake. Chest X-ray shows a circular metallic density at the level of the aortic arch (T4) with characteristic "double-ring" and "step-off" signs confirming button battery. Which of the following management approaches best represents the IMMEDIATE pre-removal mitigation strategy marked as **B** in the algorithm?
A. Administer honey 10 mL orally every 10 minutes (up to 6 doses) en route to the operating room, followed by emergent rigid endoscopic removal under general anesthesia within 2 hours of presentation
B. Observe the child for 24 hours with serial chest X-rays to assess spontaneous passage, as most button batteries pass without intervention in toddlers
Refer the child to gastroenterology for outpatient endoscopy within 48 hours after starting oral sucralfate at home
C.
D. Perform immediate Foley catheter balloon extraction in the ED without anesthesia to avoid delays in definitive management
Explanation
Why option 1 is correct
The NASPGHAN/AAP 2023 guidelines mandate IMMEDIATE pre-removal mitigation for children >12 months presenting within 12 hours of button battery ingestion. Honey (10 mL orally every 10 minutes, up to 6 doses) is the first-line agent because it is acidic, coats the battery surface, and neutralizes hydroxide ions generated at the negative pole—the primary driver of liquefactive necrosis. This must be given EN ROUTE to the operating room without delaying endoscopy. Emergent rigid or flexible endoscopy under general anesthesia with intubation must occur within 2 hours of presentation to prevent transmural burns, perforation into the aorta, trachea, or mediastinum. The battery is extracted with a Roth net or rat-toothed forceps, and the underlying mucosa is carefully inspected for depth of injury.
Why each distractor is wrong
Option 2 (watchful waiting for 24 hours): Button batteries in the esophagus are an ABSOLUTE EMERGENCY and differ fundamentally from coins. Lithium batteries (3V) cause severe transmural injury within 2 hours via pressure necrosis, alkali leakage, and electrical generation of hydroxide ions. Observation is contraindicated and risks exsanguinating hematemesis from aortoesophageal fistula, tracheoesophageal fistula, or mediastinitis. This approach is appropriate only for coins in the stomach of asymptomatic children, not button batteries in the esophagus.
Option 3 (Foley balloon extraction without anesthesia): Blind Foley catheter extraction is OBSOLETE for button batteries. It carries unacceptable risks of aspiration, incomplete removal, and blind extraction trauma to already-injured mucosa. General anesthesia with intubation and rigid/flexible endoscopy under direct visualization is the standard of care.
Option 4 (outpatient referral in 48 hours): Any delay beyond 2 hours from presentation is dangerous. A battery at the aortic arch (T4) with signs of button battery is a surgical emergency. Waiting 48 hours for outpatient endoscopy risks fatal complications including aortic perforation with exsanguinating hemorrhage, tracheoesophageal fistula, and spinal cord injury.
High-YieldNEET PG
Button battery in esophagus = ABSOLUTE EMERGENCY; give honey (if >12 months, <12 hours) + emergent endoscopy within 2 hours under GA; never observe, never use Foley balloon, never delay.
