Endoscopic Retrieval of Ingested Button Battery From a Colonic Diverticulum in an Alzheimer’s Patient: A Case Report

Introduction

Button battery (BB)-related bowel complications are life-threatening but remain poorly evaluated. Standard management of an accidentally swallowed BB involves radiographic confirmation followed by natural passage through the gastrointestinal tract, including the esophagus and stomach, until excretion via the anus. However, if the BB becomes lodged in a narrowed segment or diverticulum of the small or large intestine, intervention is required. Although cases of BB retention in Meckel’s diverticulum have been documented, no reports have described retention in a colonic diverticulum. Here, we report a case of BB retention in an ascending colonic diverticulum in an 88-year-old woman with Alzheimer’s disease, which was successfully treated via colonoscopic removal.

Case Report

An 88-year-old woman presented with a radiopaque foreign body (FB) observed on chest radiography. She had resided in a nursing home for 3 years. It was confirmed that she had opened her hearing aid and handled the battery after admission. On the day of presentation, the BB was found missing from her hearing aid, prompting radiographic evaluation for suspected aspiration. The radiograph revealed a foreign object consistent with a BB, and she was referred to our outpatient clinic for further assessment. Her medical history included Alzheimer’s disease diagnosed at age 70, epilepsy, and hypertension managed with antihypertensive medication for the past 10 years. Physical examination revealed that she was alert, with a body temperature of 36.5°C, blood pressure of 155/77 mmHg, heart rate of 73 beats/min, respiratory rate of 15 breaths/min, and oxygen saturation of 97% on room air. Abdominal examination showed a flat, soft abdomen without epigastric tenderness or muscular guarding. All laboratory results obtained from venous blood samples on admission were within normal limits (Table 1). Multi-detector computed tomography images displayed a bright FB near the duodenal bulb (Figures 1, 2). Based on the diagnosis of an ingested BB in the duodenal bulb, emergency upper gastrointestinal endoscopy was performed 2 h after admission. However, no FB was identified in the duodenum, and a concurrent abdominal radiograph demonstrated that the FB had already migrated distally beyond the ligament of Treitz (Figure 3). The patient was admitted for observation, with a plan to administer laxatives to facilitate transanal passage of the BB. A plain abdominal radiograph obtained 17 h after admission indicated that the BB had moved into the right colon (Figure 4); colonoscopy was performed on the same day to locate and remove the BB (Figure 5). The BB was extracted from the diverticulum using alligator forceps and subsequently retrieved with a retrieval net (Figure 6). The removed object was confirmed to be a BB (RAYOVAC size 13; 7.9×5.4 mm), typically used in hearing aids (Figure 7). The patient was discharged the following day after successful removal. No complications were reported, and no specific follow-up care was planned.

Discussion

FB INGESTION:

FB ingestion is a common problem in children between 6 months and 3 years of age [1]. In a report of adult FB ingestion, 56% of cases involved individuals with mental illness; the most common foreign bodies were batteries (23%), drug-filled balloons used for interventions (17%), razor blades (16%), and others (40%). Although 55% of cases were managed conservatively, two-thirds were considered high-risk in which patients showed life-threatening symptoms [2]. However, the age group in that report was younger than 30 years, and no previous reports have involved older patients similar to the present case.

STRATEGY FOR FB INGESTION:

When an FB remains in the esophagus, removal within 24 h is recommended [3], preferably within 6 to 12 h after presentation, because delayed removal increases the risk of complications [3]. Regarding FBs retained in colonic diverticula, as in the present case, current treatment guidelines for colonic diverticular disease provide no specific recommendations [4]. Diverticula are classified as either true or pseudodiverticula. True diverticula, such as Zenker’s and Meckel’s diverticula, contain all layers of the normal gastrointestinal wall; pseudodiverticula lack a muscular layer or mucosa, resulting in a higher risk of perforation. There have been 3 reports of BBs entering and perforating diverticula in the small or large intestine: 2 involved Meckel’s diverticulum [5,6] and 1 involved colonic perforation [7]. Considering the histological weakness of pseudodiverticula, as in our patient’s case, emergency colonoscopy appears appropriate for removing FBs retained in colonic diverticula to prevent complications such as perforation or abscess formation.

Conclusions

We report the case of an 88-year-old woman with Alzheimer’s disease who experienced retention of a BB in an ascending colonic diverticulum; the BB was successfully removed by colonoscopy. To our knowledge, this is the first reported case of BB retention in a colonic diverticulum. Retention of a BB in this location warrants consideration of prompt colonoscopic removal because it may pose a risk of colonic perforation.