Bradycardia After Button Battery Ingestion in a 21-Month-Old Child

Introduction: This case highlights the rapid onset of severe complications, including significant bradycardia due to vagal nerve irritation, following button battery ingestion in a child. It demonstrates that even in the absence of esophageal perforation, cardiac rhythm disturbances can occur, emphasizing the importance of immediate intervention and ongoing vigilance in such cases. Case Presentation: Main symptoms of the patient: A 21-month-old boy presented after accidental ingestion of a button battery. On admission, he was agitated but had no remarkable physical findings. Main clinical findings: Imaging revealed a 23 mm button battery impacted in the upper esophagus. Emergent endoscopy showed deep ulcerations on two-thirds of the esophageal lumen. Post-extraction, the patient developed episodes of profound sinus bradycardia, particularly during sleep, but remained hemodynamically stable. Main diagnoses and interventions: The diagnosis included esophageal injury with deep ulcerations and sinus bradycardia likely secondary to vagal nerve irritation. Interventions consisted of emergent rigid endoscopic removal of the battery, supportive care in the pediatric intensive care unit, total parenteral nutrition, antibiotics, proton pump inhibitors, and corticosteroids. No specific treatment was required for the bradycardia due to the absence of hemodynamic compromise. Main outcomes: The patient’s heart rate normalized within 3 weeks, and follow-up endoscopy after 1 month showed complete healing of the esophageal mucosa without stricture formation. Three-month Holter monitoring confirmed sustained normalization of cardiac rhythm. Conclusions: Button battery ingestion can cause life-threatening complications, including vagal nerve–mediated bradycardia, even without esophageal perforation. Early recognition, prompt endoscopic removal, and vigilant monitoring for rhythm disturbances are crucial. This case underscores the need for increased public awareness and preventive measures to reduce the incidence of button battery ingestion in children.