Button battery insertion (PilBouTox®): A prospective study of all insertion routes

Objectives Button battery (BB) insertion is less common than ingestion, but can induce local necrosis and perforation. This study aimed to evaluate the causes, clinical manifestations, and outcomes of BB insertion. Methods The PilBouTox® study was a 2-year prospective multicenter observational cohort study conducted by French poison control centers. All cases of button battery insertions were included. Cases of ingestion or a discovered Button battery in the feces were excluded. After insertion, patients were monitored for 21 days. Causes of insertion, clinical manifestations, medical management and outcome were recorded. Results We recorded 34 cases, 5 cases, and 1 case of buccal, nasal, and auricular BB insertion, respectively. No cases of ocular, rectal, or vaginal BB insertions were recorded. Children and older adults represented 88% and 3% of patients, respectively. The incidence of BB insertion was 3.4 cases/1,000,000 children/year. Mucosal erosion and necrosis were described 1h and 12h after BB insertion, respectively. In one case of nasal insertion, the BB was subsequently swallowed. All patients with quick BB extraction (less than 15min) remained asymptomatic. No patients died or had sequelae during the 21 days of follow-up. Conclusion BB insertion is rare. Local necrosis can appear within a few hours after the insertion. Long-term complications need to be monitored to avoid missing functional injuries.