Emergency Management of the Ingested Magnet

et al. 2020

BMC Pediatr

Purpose: To describe the incidence and management of gastrointestinal tract Buckyball magnets ingestions in a multicenter Chinese pediatric patient population, and discuss the preventive measures. Methods: Medical records of 74 pediatric patients from 9 large Chinese hospitals during the past 10 years, who were diagnosed as buckyball magnets ingestion and got invasive treatment, were retrospectively studied. The follow-up was through telephone and outpatient service to estimate the post-surgery condition. Information collection was through online questionnaire. Results: Among the 74 cases, there were 50 boys (68%) and 24 girls (32%). The median age was 36 (interquartile range (IQR) 22-77) months, with a range of 7 months to 11 years, and it showed two peaks, the first between 1 and 3 years, and the second between 6 to 11 years. The annual case number showed a sharp increase over time, and the total case number in the last 2 years (2017 and 2018) showed a greater than 9-fold increase when compared with the first 2 years (2013 and 2014). The majority of ingestions were unintentional, with only 3 patients deliberately swallowing the Buckyball magnets. The median time of ingestion until the onset of emergent symptoms was 2 (IQR 1-5) days, and ranged from 4 h to 40 days. Twenty-one patients had no symptoms, and the remaining cases presented with abdominal pain, vomiting, fever, abdominal distension, excessive crying, melena, and the ceasing of flatus and defecation. Gastroscopy, colonoscopy, laparoscopic surgery and laparotomy surgery were performed in accordance with the algorithm from the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Procedural and operative findings included gastrointestinal mucosa erosion, ischemia and necrosis, perforation, and abdominal abscess, fistula and intestinal obstruction. The median number of Buckyball magnets ingested was 4 (IQR 2-8), with a range from 1 to 39. During the median follow-up period of 6 (IQR 1-15) months, 3 patients had intestinal obstruction, and one underwent a second operation. The remaining 71 patients courses were uneventful during the follow-up period. None of the 74 patients reported a second swallowing of foreign bodies. Conclusions: The incidence of pediatric gastrointestinal tract magnets ingestion in China is increasing. Management of such patients should follow the NASPGHAN algorithm. Preventive measures to limit children's access to Buckyball magnets should be taken from three levels, namely the national administration, producer, and consumer.

Section: Discussionmentioning

confidence: 99%

Multicenter investigation of pediatric gastrointestinal tract magnets ingestion in China

et al. 2020

BMC Pediatr

“…Unlike other foreign bodies, ingested magnets can attract each other across bowel loops, and cause gastrointestinal wall ischemia, pressure necrosis or perforation [8][9]. Other studies also described intestinal obstruction from internal hernia and volvulus of intestine, fistula formation [10], and hemorrhage when the mesenteric was involved [10]. Midget J reported a twenty-month old boy who had ingested magnets, causing intestinal necrosis and abdominal sepsis, which led to death [11][12].…”

Section: Discussionmentioning

confidence: 99%

Multicenter investigation of pediatric alimentary tract magnets ingestion in China

et al. 2019

Preprint

Purpose: To describe the incidence and management of alimentary tract Buckyball ingestion in Chinese pediatric patients, and discuss the precautionary measures through a multicenter investigation. Methods: Medical records of 74 pediatric patients from 9 large Chinese hospitals were included in this study. Questionnaires were distributed online, and medical records were reviewed. Follow-up was through telephone and outpatient service. Results: Among the 74 cases were 50 boys (68%) and 24 girls (32%). The median age was 36 (22, 77) months, with a range of 7 months to 11 years old, and it showed two peaks. The annual case number showed a sharp increase, and the total case number in the last 2 years (2017 and 2018) showed a greater than 9-fold increase when compared with the first 2 years (2013 and 2014). The majority of ingestions were unintentional, with only 3 patients deliberately swallowing the Buckyball. The median time of ingestion until the onset of emergent symptoms was 2 (1, 5) days, and varied from 4 hours to 40 days. 21 patients had no symptoms, and the remaining cases presented with abdominal pain, vomiting, fever, abdominal distension, excessive crying, melena, and the ceasing of flatus and defecation. Gastroscopy, colonoscopy, laparoscopic surgery and laparotomy surgery were adopted according to the algorithm from the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Gastrointestinal mucosa erosion, ischemia and necrosis, perforation, and abdominal abscess, ileus and fistula was found in the patients. The median number of Buckyballs ingested was 4 (2, 8), with a range from 1 to 39. During the follow-up period of 6 (1, 15) months, 3 patients had ileus, and one underwent a second operation. The remaining 71 patients were uneventful. None of the 74 patients reported a second swallowing of foreign bodies. Conclusions: The incidence of pediatric alimentary tract magnets ingestion in China is still increasing. Management of such patients should follow the algorithm from NASPGHAN. Precautionary measures toward the issue should be taken from three levels, namely the national administration, producer, and consumer. Keywords: Pediatric, Alimentary tract, Magnetic foreign body, Buckyball

“…Different from other foreign bodies, ingested magnets will attract each other across bowel loops, and cause gastrointestinal wall ischemia, pressure necrosis or perforation, especially when swallowed separately [7][8]. Other studies also described intestinal obstruction from internal hernia and volvulus of intestine, fistula formation [9], and hemorrhage when the mesenteric involved [9]. Midget J reported a 20 months old boy who had such foreign body ingested, causing intestinal necrosis and abdominal sepsis, which led to the tragedy death [10][11].…”

Section: Discussionmentioning

confidence: 99%

Multicenter study of pediatric alimentary tract magnetic foreign body ingestion in China

et al. 2019

Preprint

Background: To investigate the alimentary tract Buckyball injuries in Chinese pediatric patients, and describe the managements and precautionary measures through multicenter investigation. Methods: Medical records of 74 pediatric patients from 9 large Chinese third-grade class-A hospitals were included in this study. Questionnaires were distributed online, and medical records were reviewed. Follow-ups were through telephone and outpatient service. Results: Among the 74 cases were 50 boys (68%) and 24 girls (32%). The age was 36.00 (21.75, 77.00) months, range from 7 months to 11 years old, and it showed two peaks, between one and three years old, and from six to eleven years old. The annual case numbers showed sharp increase, and Hebei Province had the largest number of 23 cases. Only 3 of them had exact reasons for swallowing the balls, the rest 71 patients had no intension for the ingestion. From onset to the emergency department time was 2.00 (1.00, 5.25) days, varied from 4 hours to 40 days. Twenty-one patients had no symptoms, and abdominal pain, vomiting, fever, abdominal distension, fiercely crying, melena, and flatus and defecation stopped were in 40 (54.05%), 36 (48.65%), 11 (14.86%), 3 (4.05%), 3 (4.05%), 2 (2.70%), 1 (1.35%) cases. Gastroscope, coloscope, laparoscopic operation, and laparotomy operation were adopted. Gastrointestinal perforation, ischemia and necrosis of gastrointestinal wall, abscess, ileus, fistula was found in 38 (51.53%), 14 (18.92%), 7 (9.46%), 6 (8.11%), 2 (2.70%), other 28 (37.84%) patients had gastrointestinal mucosa erosion. The numbers of Buckyball ingested was 4 (2, 8), with a range from 1 to 39. During the follow-up period of 6 (1, 15) months, three patients had ileus, and one suffered a second operation. The remaining 71 patients were uneventful. None of the 74 patients reported a second time swallowing of Buckyballs or other magnetic foreign bodies. Conclusions: Pediatric alimentary tract magnetic foreign body ingestion in China is still increasing. Treatments and managements are of great significance, while prevention is more important and time critical. Precautionary measures toward the issue should be taken from three levels. Keywords: Pediatric, Alimentary tract, Magnetic foreign body, Buckball