SAEM Clinical Images Series: Tuning In

KUB

The patient is an 85-year-old male with a history of anxiety/depression, hypertension, hyperlipidemia, and hearing loss who presents to the Emergency Department after having transient painful swallowing. He states he took several of his pills at once in one swallow this morning as prescribed, then shortly afterwards felt a sharp discomfort moving down his esophageal region. The pain seemed to migrate down to his stomach, then his pain resolved. He has since been pain free and is tolerating his secretions well, but he has not eaten or drank anything since the incident. He denies chest pain, abdominal pain, nausea, or vomiting and has no other complaints at this time.

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foreign body

Vitals: BP 138/70 HR 68 R 18 T 98.7 O2sat 98% room air.

HEENT: Mouth- unremarkable. Pharynx: mild posterior erythema without tonsillar swelling or exudates.

Neck: normal thyroid gland, no lymphadenopathy or swelling.

Respiratory: Clear to auscultation bilaterally.

Cardiovascular: Regular rate and rhythm, no murmurs.

Abdomen: Soft and non-tender, bowel sounds present.

CBC: WBC 7.5, Hgb 14.1, Plt 244,000

CMP: normal

The X-ray shows an ingested hearing aid containing a battery.

Gastrointestinal perforation.

The abdominal X-ray reveals a swallowed hearing aid containing a battery. X-rays can determine the location of radiopaque ingested objects. While most hearing aid batteries are sealed within a compartment reducing the risk of mucosal erosion, the battery could dislodge and cause damage and perforation. Severe complications can arise if batteries are in the esophagus, where they can cause rapid corrosive injury, perforation, and mediastinitis. Any button battery lodged in the esophagus must be emergently removed for this reason. Button batteries that have cleared the stomach usually pass through the colon within one week without complications. If the object has not passed in 10-14 days, imaging should be completed to verify the location. However, any patient who develops abdominal pain, hematochezia, or fever before battery passage in the stool has been confirmed should seek emergent care, as these symptoms could indicate intestinal perforation or lodging of the battery in the appendix.

Take-Home Points

  • Always obtain imaging to verify the location of ingested battery or other suspected radiopaque foreign bodies.
  • Esophageal impactions can cause life-threatening mediastinitis.
  • Foreign bodies are most likely to lodge in areas of physiologic narrowing: the cricopharyngeus muscle (upper esophageal sphincter), the level of the aortic arch, and the lower esophageal sphincter.


Litovitz T, Whitaker N, Clark L, et al. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010; 125:1168. 2. Green SM, Schmidt SP, Rothrock SG. Delayed appendicitis from an ingested foreign body. Am J Emerg Med 1994; 12:53.

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Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2025 SAEM Annual Meeting | Copyrighted by SAEM 2025 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.