Nasal button battery
Updates to Study Attributes
The patient proceedproceeds to theatre some 4-5 hours of inserting the battery. AAn LR44 alkaline battery was removed from the right nasal cavity just posterior to the internal nasal valve. The battery showed significant signs of hydrolysis.
Extensive but apparent superficial burns were visualised in the nasal cavity limited to the septum, lateral nasal wall (mainly inferior turbinate) and floor. The nasopharynx was unaffected. The nasal cavity was irrigated and topical antibiotic ointment applied.
Updates to Case Attributes
Ingested, inhaled or inserted button batteries require a high index of suspicion and prompt medical attention. A range of different button batteries are available including alkaline, lithium, manganese, mercury, silver and zinc. Batteries contain an anode, cathode and electrolyte soaked spacer 1.
A number of mechanisms by which batteries cause injury have been proposed including; leakage of battery contents, local pressure/ischaemic necrosis, local current and alkaline fluid generation through contact with moist mucosa (nasal or gastrointestinal) resulting in caustic and electrical burns in the surrounding tissue 2.
Button batteries can cause damage within hours of ingestion/insertion and require prompt identification and referral for removal. Delayed battery removal from the nose can result in mucosal ulceration, epistaxis, septal perforation, saddle deformities, chondritis, atrophic rhinitis, alar collapse, and nasal/choanal stenosis 3. Delayed battery removal from the digestive tract can cause catastrophic complication including perforation, tracheal-oesophageal fistula or oesophago-aortic fistula 4.
Radiologically it is important to identify button battery compared to anotherother radiopaque foreign bodies such as a coin. Frontal radiographs will typically demonstrate a halo/double density sign alerting the presence of a button battery. Where clinical doubt exists an orthogonal lateral radiograph should be obtained which usually reveals a stepped profile 2. Given the plane of the button battery in this case the frontal view revealed the stepped profile, and the lateral the halo/double density sign.
-<p>Ingested, inhaled or inserted button batteries require a high index of suspicion and prompt medical attention. A range of different button batteries are available including alkaline, lithium, manganese, mercury, silver and zinc. Batteries contain an anode, cathode and electrolyte soaked spacer <sup>1</sup>.</p><p>A number of mechanisms by which batteries cause injury have been proposed including; leakage of battery contents, local pressure/ischaemic necrosis, local current and alkaline fluid generation through contact with moist mucosa (nasal or gastrointestinal) resulting in caustic and electrical burns in the surrounding tissue <sup>2</sup>.</p><p>Button batteries can cause damage within hours of ingestion/insertion and require prompt identification and referral for removal. Delayed battery removal from the nose can result in mucosal ulceration, epistaxis, septal perforation, saddle deformities, chondritis, atrophic rhinitis, alar collapse, and nasal/choanal stenosis <sup>3</sup>. Delayed battery removal from the digestive tract can cause catastrophic complication including perforation, tracheal-oesophageal fistula or oesophago-aortic fistula<sup> 4</sup>.</p><p>Radiologically it is important to identify button battery compared to another radiopaque foreign bodies such as a coin. Frontal radiographs will typically demonstrate a halo/double density sign alerting the presence of a button battery. Where clinical doubt exists an orthogonal lateral radiograph should be obtained which usually reveals a stepped profile <sup>2</sup>. Given the plane of the button battery in this case the frontal view revealed the stepped profile, and the lateral the halo/double density sign.</p><p> </p>- +<p>Ingested, inhaled or inserted button batteries require a high index of suspicion and prompt medical attention. A range of different button batteries are available including alkaline, lithium, manganese, mercury, silver and zinc. Batteries contain an anode, cathode and electrolyte soaked spacer <sup>1</sup>.</p><p>A number of mechanisms by which batteries cause injury have been proposed including; leakage of battery contents, local pressure/ischaemic necrosis, local current and alkaline fluid generation through contact with moist mucosa (nasal or gastrointestinal) resulting in caustic and electrical burns in the surrounding tissue <sup>2</sup>.</p><p>Button batteries can cause damage within hours of ingestion/insertion and require prompt identification and referral for removal. Delayed battery removal from the nose can result in mucosal ulceration, epistaxis, septal perforation, saddle deformities, chondritis, atrophic rhinitis, alar collapse, and nasal/choanal stenosis <sup>3</sup>. Delayed battery removal from the digestive tract can cause catastrophic complication including perforation, tracheal-oesophageal fistula or oesophago-aortic fistula<sup> 4</sup>.</p><p>Radiologically it is important to identify button battery compared to other radiopaque foreign bodies such as a coin. Frontal radiographs will typically demonstrate a halo/double density sign alerting the presence of a button battery. Where clinical doubt exists an orthogonal lateral radiograph should be obtained which usually reveals a stepped profile <sup>2</sup>. Given the plane of the button battery in this case the frontal view revealed the stepped profile and the lateral the halo/double density sign.</p><p> </p>
Updates to Freetext Attributes
An attempt to remove the foreign body was unsuccessful by the emergency team and prompt referral was made to the Ear, Nose and Throat team. Unfortunately, the patient was too distressed to allow another attempt at removal in the emergency department and proceeded to theatre.