• David E Brumbaugh, Steven B Colson, John A Sandoval, Frederick M Karrer, John F Bealer, Toby Litovitz, and Robert E Kramer.
• Department of Pediatrics, Section on Pediatric Gastroenterology, Hepatology, and Nutrition, University of Colorado Denver School of Medicine, and Children's Hospital, Aurora, Colorado 80045, USA. Brumbaugh.david@tchden.org
• J. Pediatr. Gastroenterol. Nutr. 2011 May 1; 52 (5): 585-9.

ObjectivesButton battery ingestions are potentially life threatening for children. Catastrophic and fatal injuries can occur when the battery becomes lodged in the esophagus, where battery-induced injury can extend beyond the esophagus to the trachea or aorta. Increased production of larger, more powerful button batteries has coincided with more frequent reporting of fatal hemorrhage secondary to esophageal battery impaction, but no recommendations exist for the management of button battery-induced hemorrhage in children.Materials And MethodsWe reviewed all of the reported pediatric fatalities due to button battery-associated hemorrhage. Our institution engaged subspecialists from a wide range of disciplines to develop an institutional plan for the management of complicated button battery ingestions.ResultsTen fatal cases of button battery-associated hemorrhage were identified. Seven of the 10 cases have occurred since 2004. Seventy percent of cases presented with a sentinel bleeding event. Fatal hemorrhage can occur up to 18 days after endoscopic removal of the battery. Guidelines for the management of button battery-associated hemorrhage were developed.ConclusionsPediatric care facilities must be prepared to act quickly and concertedly in the case of button battery-associated esophageal hemorrhage, which is most likely to present as a "sentinel bleed" in a toddler.

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