SAEM Clinical Images Series: Tuning In

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.