Pediatric button battery associated spondylodiscitis after delayed endoscopic removal: A case report and literature review

Spondylodiscitis is a rare complication of pediatric button battery (BB) ingestion with 12 reported cases. Delayed BB removal tends to be the underlying scenario. A posteriorly oriented BB anode on radiographs may also be a pattern seen in these cases. We report the case of a 2-year-old male with chronic intermittent upper respiratory symptoms, initially managed expectantly, without imaging. The child had no neurological symptoms or neck pain. Five months after symptom onset, radiographs unexpectedly revealed an esophageal BB with a posteriorly oriented anode. Emergent endoscopic removal was performed, and multiple BB-related complications were identified. CT and MRI demonstrated T2-T4 spondylodiscitis with chronic osseous bridging. The child was treated with IV antibiotics and was without related clinical sequelae 1 year later. While rare, spondylodiscitis should be sought out in cases of delayed BB removal. Since the absence of neurologic symptoms may not reliably exclude spondylodiscitis, the diagnosis heavily relies upon imaging. CT and MRI both play key roles, but MRI of the cervical and thoracic spine is the study of choice. Radiologists can play a key role in early diagnosis by being familiar with this unique entity.