IMAGE | ENDOSCOPY Cylindrical Batteries in the Stomach: Should We Wait 48 Hours for Removal?

A 31-year-old woman presented with witnessed ingestion of multiple cylindrical batteries to deliberately self-harm 2 hours prior to admission. The patient denied any symptoms. Physical exam was normal. Abdominal series showed 7 cylindrical batteries (5 AAA and 2 AA) in the upper abdomen (Figure 1). Esophagogastroduodenoscopy (EGD) under conscious sedation revealed food remnants in the stomach. Despite extensive irrigation and suctioning only 2 batteries were visualized in the stomach and both were successfully retrieved using a Roth net. No mucosal damage was apparent. The next morning, she complained of mild abdominal pain with mild epigastric tenderness. Abdominal x-ray revealed 4 batteries in the stomach, and another in the small bowel. The patient underwent repeat EGD under general anesthesia within 12 hours of the ingestion time. Stomach exam revealed 3 batteries in the body with 3 deep ulcerations (2 in the antrum and 1 in the incisura) and multiple erosions (Figure 2). Duodenal exam showed superficial mucosal erosions, and another battery was seen beyond the ligament of Treitz