Double button battery ingestion - The “macaroon” sign

0.25% acetic acid was used as a neutralising agent at the time of button battery removal (8 h after ingestion), based on published evidence that this effectively decreases tissue pH and mitigates the severity of the injury in animal models, whilst not increasing ambient tissue temperature as once thought [4]. Our patient had a significantly better clinical outcome than predicted from the severity of the burn at time of button battery removal, suggesting acetic acid used topically is a safe adjunct treatment of impacted ingested button batteries and may reduce the likelihood of serious long term sequelae.