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Serial x rays in battery ingestion
  1. Stewart Teece, Specialist Registrar,
  2. Kevin Mackway-Jones, Professor
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether serial x rays were necessary in cases of battery ingestion where the battery has passed through the oesophagus. A total of 104 papers were found using the reported search, of which none presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.

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    Report by Stewart Teece, Specialist RegistrarChecked by Kevin Mackway-Jones, Professor

    Clinical scenario

    A mother brings her 3 year old to the department, concerned that she has swallowed a battery. X ray reveals a metallic opacity in the abdomen which could very likely be a battery. You reassure the mother but she is concerned about the passage of the battery and wants to come back for a repeat film. You wonder whether you should perhaps make sure that it’s passing distally to prevent it decaying inside the body.

    Three part question

    In [children who have swallowed batteries] do [serial abdominal x rays] reduce the [incidence of perforation and need for later intervention]?

    Search strategy

    Medline 1966–April week 4 2005 and Embase 1980–week 19 2005 using the OVID interface. Medline: [Battery.mp OR batteries.mp] AND [ingestion.mp OR swallow$.mp OR eat$.mp} AND {perforat$.mp OR corrode.mp OR exp corrosion OR corrosion.mp]. A total of 28 papers found. Embase: [exp electric battery OR battery.mp OR batteries.mp] AND [ingestion.mp OR exp ingestion OR exp swallowing OR swallow$.mp OR eat$.mp] AND exp duodenal perforation OR exp perforation OR perforate$.mp OR corrode$.mp OR exp corrosion OR corrosion.mp]. A total of 21 papers found.

    Search outcome

    Overall 29 papers found, of which none contained any data to answer the question posed.

    Comment(s)

    A number of authors expressed a personal view that serial x rays were necessary to ensure that the battery had been passed, but none offered any direct evidence for this. Other authors felt that “nature should be allowed to take its course”, but again none offered supporting evidence.

    CLINICAL BOTTOM LINE

    Some research is required to clarify whether there is a need for serial x rays after battery ingestion. In the mean time local expert advice should be followed.

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