Pardeep Taunk, MD1, Pawel Szurnicki, MD2, John W. Trillo, MD1; 1Coney Island Hospital, Brooklyn, NY; 2New York City Department of Health and Mental Hygiene, Brooklyn, NY
Introduction: Disk battery ingestion is commonly seen in the pediatric population and rarely in adults. There are no guidelines on how to manage these in the lower GI tract. We present a rare case of a disk battery impacted in the lower GI tract in an adult patient.
Methods: A 96 year-old-male with a history of Alzheimer’s disease presented for concerns that he had ingested a battery. Physical examination was remarkable for altered mental status. Abdominal x-ray revealed a coin like lesion in the RLQ (Figure 1). CT scan of abdomen and pelvis confirmed a radiopaque object at the ileo-cecal junction (Figure 2), believed to be a disk battery. Colorectal surgery was consulted for colonoscopic removal with possible surgical conversion but the health care proxy refused and instead opted for conservative management/non-invasive measures. Multiple trials of bowel regimens including polyethylene glycol were initiated to induce dislodgement without success as serial abdominal x-rays revealed that the battery remained impacted in the same location (Figure 3). At this point, the health-care proxy opted for discharge to a nursing home with supportive measures. Discussion: Current guidelines recommend removal if the battery is lodged in the esophagus, if the battery is in the stomach and is less than 2cm in size, conservative management is advised as it will likely pass through the GI tract. Progression should be followed with serial abdominal x-rays every 3 days and if impaction is suspected, the battery should be removed. Currently no guidelines on impacted objects in the lower GI tract exist, but we hypothesize that if the object is less than 2cm, it will likely be evacuated. The major risk of foreign body ingestion is perforation. This occurs from penetration of the mucosa or via pressure injury from impaction. Lithium-Ion batteries have a high risk of electrical thermal injury leading to liquefaction necrosis and Nickel-Cadmium batteries can cause caustic injuries. Regardless, they both carry an increased risk of perforation, especially with impaction. In our case, the patient was given multiple bowel regimens to induce dislodgement. Although serial imaging did not show progression of the battery, to our knowledge, there are no other cases in which bowel regimens have been used for managing lower GI tract foreign objects and this creates a need for further investigation.