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The Perspective
The Perspective

February 19, 2016

Swallowed objects: a closer look

Dr. Blake Papsin is Otolaryngologist-in-Chief at SickKids. He is also Professor in the Department of Otolaryngology – Head and Neck Surgery at the University of Toronto and the Jordan and Lisa Gnat Family & Bastable-Potts Chair in Otolaryngology at SickKids.

Given the recent news stories and being a surgeon who has been extracting swallowed objects for the past 20 years, I will say that swallowing small household objects like batteries is not an uncommon occurrence. Here’s my take:   

If a future society wanted to study a past, I think one of the best methods would be to examine the foreign bodies that their children ingested. We have been collecting foreign bodies that children have lodged in their esophagi since the early 1900s and examination of this collection can be very revealing. For example, there were very few coins ingested during the Great Depression when money had such value it wasn’t left lying around. When diapers were fastened with safety pins they were a common ingested foreign body and were quite difficult to remove. Thankfully those are now replaced by Velcro. When I travelled on medical missions to Ethiopia I was always struck by the fact that they were still dealing with caustic ingestion of lye and cleaning fluids. Those injuries are virtually unknown in North America since we passed laws to safely package and limit access to these caustic materials. Batteries, on the other hand, are items upon which we as a society rely and as they have become smaller and more powerful they have become an increasingly common ingested foreign body.

In truth, ingestion of small, circular lithium batteries represents a very small proportion of foreign bodies ingested by children. Many of the smaller batteries, for example, those found in a hearing aid, pass through the gastrointestinal system uneventfully. We hear more about the larger ones that tend to get stuck, like a coin would, and cause significant issues. What is true is that although the number of batteries that get stuck in the esophagus is quite small the frequency is rising annually. Although we never hear how many pass without incident there are more and more cases reported when there have been devastating outcomes.

Small, shiny, discarded lithium batteries are very attractive to young and curious infants and children. Even if the battery is spent it still has enough power to cause a significant injury to a child’s esophagus. The injury occurs when the battery becomes lodged in one place and slowly discharges whatever power it has left into the surrounding tissues. This can cause a lethal complication within hours depending on how much power is in the battery and where it gets lodged. Usually it gets stuck high up in the esophagus and simply burns the tissue surrounding it. As you might expect, that is quite painful and prohibits swallowing any other materials. These are the symptoms that bring the children into the hospital. Once there, these symptoms usually are investigated with an X-ray which should clearly show a halo around the circular foreign body and a step when viewed from the side that are characteristic of a battery. At this point emergency removal with surgery is required.

Once we remove the battery we will wash the area often with cold water to try and remove as much of the burned tissue as is possible. Thankfully most of these heal perfectly but occasionally there are narrowed regions in the esophagus that need to be treated.

The best way to prevent this injury is to take great care when discarding lithium batteries after use, and to closely supervise children when they are playing with battery-operated objects. We can’t rely on manufacturers and laws to protect our children entirely. As a society, the responsibility to provide a safe environment is mostly ours.