Button battery ingestion

Lithium button batteries (especially 20 mm CR2032) lodging in the oesophagus generate hydroxide at the negative pole, causing liquefactive necrosis within 2 hours. Catastrophic complications: tracheo-oesophageal fistula, aorto-oesophageal fistula (sudden massive haematemesis 1–2 weeks later), mediastinitis, vocal cord paralysis. Mortality reported. ABCDE. Most cases: well child or adult brought in by carer. Note symptoms: drooling, refusing feeds, dysphagia, chest pain, haematemesis, melena, cough — but ASYMPTOMATIC presentation does NOT exclude impaction. Urgent investigation: • AP + lateral chest/abdominal X-ray (entire neck to anus): identify location, orientation. Button battery shows a "step-off" or "halo" sign vs. coin (look on lateral). • If unwitnessed ingestion: IMAGE NOW — don't wait for symptoms. Activate paediatric ENT / upper-GI endoscopy / anaesthetics simultaneously.