Context: Button battery ingestion is a frequent pediatric complaint. The serious complications resulting from accidental ingestion have increased significantly over the last two decades due to easy access to gadgets and electronic toys. Over recent years, the increasing use of lithium batteries of diameter 20 mm has brought new challenges, because these are more detrimental to the mucosa, compared with other types, with high morbidity and mortality. The clinical complaints, which are often nonspecific, may lead to delayed diagnosis, thereby increasing the risk of severe complications. Case Report: A five-year-old boy who had been complaining of abdominal pain for ten days, was brought to the emergency service with a clinical condition of hematemesis that started two hours earlier. On admission, he presented pallor, tachycardia and hypotension. A plain abdominal x-ray produced an image suggestive of a button battery. Digestive endoscopy showed a deep ulcerated lesion in the esophagus without active bleeding. After this procedure, the patient presented profuse hematemesis and severe hypotension, followed by cardiorespiratory arrest, which was reversed. He then underwent emergency exploratory laparotomy and presented a new episode of cardiorespiratory arrest, which he did not survive. The battery was removed through rectal exploration. Conclusion: This case describes a fatal evolution of button battery ingestion with late diagnosis and severe associated injury of the digestive mucosa. A high level of clinical suspicion is essential for preventing this evolution. Preventive strategies are required, as well as health education, with warnings to parents, caregivers and healthcare professionals.1323184188Martins, C.B., Andrade, S.M., Acidentes com corpo estranho em menores de 15 anos: Análise epidemiológica dos atendimentos em pronto-socorro, internacções e óbitos [Accidents with foreign bodies in children under 15 years of age: Epidemiological analysis of first aid services, hospitalizations, and deaths] (2008) Cad Saude Publica., 24 (9), pp. 1983-1990Baracat, E.C.E., Paraschin, K., Nogueira, R.J.N., Acidentes com crianças e sua evolução na região de Campinas, SP [Accidents with children in the region of Campinas, Brazil] (2000) J Pediatr (Rio J)., 76 (5), pp. 368-374Ospina Nieto, J., Posada Castrillón, M.E., Cuerpos estrãnos en tracto gastrointestinal en niños [Foreign bodies in gastrointestinal tract in children] (2008) Rev Colomb Gastroenterol., 23 (3), pp. 233-238Yardeni, D., Yardeni, H., Coran, A.G., Golladay, E.S., Severe esophageal damage due to button battery ingestion: Can it be prevented? (2004) Pediatr Surg Int., 20 (7), pp. 496-501Litovitz, T., Schmitz, B.F., Ingestion of cylindrical and button batteries: An analysis of 2382 cases (1992) Pediatrics., 89 (4 PART 2), pp. 747-757Litovitz, T., Whitaker, N., Clark, L., Preventing battery ingestions: An analysis of 8648 cases (2010) Pediatrics., 125 (6), pp. 1178-1183Chang, Y.J., Chao, H.C., Kong, M.S., Lai, M.W., Clinical analysis of disc battery ingestion in children (2004) Chang Gung Med J., 27 (9), pp. 673-677Injuries from batteries among children aged < 13 years--United States, 1995-2010 (2012) MMWR Morb Mortal Wkly Rep., 61 (34), pp. 661-666. , Centers for Disease Control and Prevention (CDC)Soccorso, G., Grossman, O., Martinelli, M., 20 mm lithium button battery causing an oesophageal perforation in a toddler: Lessons in diagnosis and treatment (2012) Arch Dis Child., 97 (8), pp. 746-747Tanigawa, T., Shibata, R., Katahira, N., Ueda, H., Battery ingestion: The importance of careful radiographic assessment (2012) Intern Med., 51 (18), pp. 2663-2664Tan, A., Wolfram, S., Birmingham, M., Neck pain and stiffness in a toddler with history of button battery ingestion (2011) J Emerg Med., 41 (2), pp. 157-160Sudhakar, P.J., Al Dossary, J., Malik, N., Spondylodiscitis complicated by the ingestion of a button battery: A case report (2008) Korean J Radiol., 9 (6), pp. 555-558Harjai, M.M., Ramalingam, W., Chitkara, G., Katiyar, A., Corrosive tracheo-esophageal fistula following button battery ingestion (2012) Indian Pediatr., 49 (2), pp. 145-146Mortensen, A., Hansen, N.F., Schiødt, O.M., Fatal aortoesophageal fistula caused by button battery ingestion in a 1-year-old child (2010) Am J Emerg Med., 28 (8), pp. 984+e5-6Jarugula, R., Dorofaeff, T., Oesophageal button battery injuries: Think again (2011) Emerg Med Australas., 23 (2), pp. 220-223Ozokutan, B.H., Ceylan, H., Yapici, S., Simsik, S., Perforation of Meckel's diverticulum by a button battery: Report of two cases (2012) Ulus Travma Acil Cerrahi Derg., 18 (4), pp. 358-360Imamoǧlu, M., Cay, A., Koşucu, P., Ahmetoǧlu, A., Sarihan, H., Acquired tracheo-esophageal fistulas caused by button battery lodged in the esophagus (2004) Pediatr Surg Int., 20 (4), pp. 292-294Bernstein, J.M., Burrows, S.A., Saunders, M.W., Lodged oesophageal button battery masquerading as a coin: An unusual cause of bilateral vocal cord paralysis (2007) Emerg Med J., 24 (3), pp. e15Gordon, A.C., Gough, M.H., Oesophageal perforation after button battery ingestion (1993) Ann R Coll Surg Engl., 75 (5), pp. 362-364Grisel, J.J., Richter, G.T., Casper, K.A., Thompson, D.M., Acquired tracheoesophageal fistula following disc-battery ingestion: Can we watch and wait? (2008) Int J Pediatr Otorhinolaryngol., 72 (5), pp. 699-706Takagaki, K., Perito, E.R., Jose, F.A., Heyman, M.B., Gastric mucosal damage from ingestion of 3 button cell batteries (2011) J Pediatr Gastroenterol Nutr., 53 (2), pp. 222-223Marom, T., Goldfarb, A., Russo, E., Roth, Y., Battery ingestion in children (2010) Int J Pediatr Otorhinolaryngol., 74 (8), pp. 849-854Sharpe, S.J., Rochette, L.M., Smith, G.A., Pediatric battery-related emergency department visits in the United States, 1990-2009 (2012) Pediatrics., 129 (6), pp. 1111-1117Kimball, S.J., Park, A.H., Rollins III, M.D., Grimmer, J.F., Muntz, H., A review of esophageal disc battery ingestions and a protocol for management (2010) Arch Otolaryngol Head Neck Surg., 136 (9), pp. 866-871Litovitz, T., Whitaker, N., Clark, L., White, N.C., Marsolek, M., Emerging battery-ingestion hazard: Clinical implications (2010) Pediatrics., 125 (6), pp. 1168-1177Chung, S., Forte, V., Campisi, P., A review of pediatric foreign body ingestion and management (2010) Clinical Pediatric Emergency Medicine., 11 (3), pp. 225-230. , http://www.clinpedemergencymed.com/article/S1522-8401(10)00040-6/abstract, Available from: Accessed in 2013 (Aug 20)Blatnik, D.S., Toohill, R.J., Lehman, R.H., Fatal complication from an alkaline battery foreign body in the esophagus (1977) Ann Otol Rhinol Laryngol., 86 (5 PART 1), pp. 611-615Brumbaugh, D.E., Colson, S.B., Sandoval, J.A., Management of button battery-induced hemorrhage in children (2011) J Pediatr Gastroenterol Nutr., 52 (5), pp. 585-589Tanaka, J., Yamashita, M., Yamashita, M., Kajigaya, H., Esophageal electrochemical burns due to button type lithium batteries in dogs (1998) Vet Hum Toxicol., 40 (4), pp. 193-196