The hidden danger of button battery ingestion: two cases and a systematic review of delayed spondylodiscitis, with a proposed surveillance framework

Pediatric button battery ingestion (BBI) is a medical emergency. While acute complications are well recognized, delayed spondylodiscitis following esophageal BBI is a rare, serious, and under-recognized complication. Diagnosis is challenging due to a clinically silent latency period and initially non-diagnostic imaging. This study aims to characterize recurrent clinical and radiological patterns, describe the timeline of delayed presentation, and propose an expert‑based surveillance framework for post‑extraction monitoring. We report two new cases of delayed spondylodiscitis after esophageal BBI and conducted a PRISMA‑compliant systematic review of PubMed, Embase, Web of Science, and Scopus from inception to February 2026. Two reviewers independently screened studies and extracted data on patient characteristics, battery features, esophageal impaction, latency period, imaging evolution, management, and outcomes. Eleven patients (median age 14 months) were analyzed. Recurrently observed features included a large battery (≥ 20 mm in 7/8 patients, 87.5%), cervicothoracic esophageal impaction, and posterior‑facing negative pole (6/6 patients with documented orientation, 100%). Early post-extraction contrast esophagrams showed no leakage in all patients with reported results (5/5, 100%). After a median latency of 3 weeks (range, 1–5 weeks), the most frequent delayed manifestations were neck pain, stiffness, restricted movement, or abnormal posturing (8/11, 72.7%) and fever (5/11, 45.5%). MRI consistently confirmed prevertebral inflammation and spondylodiscitis involving the cervicothoracic region. None of the reported patients underwent spinal debridement or fusion (0/11, 0%). A normal early esophagram or radiograph does not exclude occult deep tissue injury after esophageal BBI. Surveillance intensity should be individualized according to battery characteristics, anatomical location, estimated impaction duration, battery orientation, and the severity of posterior esophageal injury. Clinicians should maintain vigilance during the first 5 weeks after battery removal, and delayed neck-related, systemic, or neurological symptoms should prompt MRI.