Introduction.
Magnetic foreign bodies of the gastrointestinal tract are a relatively rare problem of pediatric urgent surgery, meanwhile, in the structure of foreign bodies they are the most difficult both in terms of timely diagnosis and treatment. There are no generally accepted therapeutic and diagnostic standards, traditional algorithms for managing patients with foreign bodies, focused on dynamic observation, are not correct; algorithms described in foreign literature contradict each other. The frequency of surgical interventions is high, and the risk of complications is high. Surgical tactics leave many "white spots". All of this leaves this issue open for discussion.
Materials and methods.
The experience of treating 76 patients with magnetic foreign bodies of the gastrointestinal tract in four pediatric surgical hospitals for the period 2010-2023 was analyzed. The study included patients with neodymium magnetic balls from the constructor – 38 people (50%), 30 people (39.5%) with neodymium magnets of a different shape and purpose, 6 people (7.9%) with ferrite magnets, 2 people (2.6%) with magnets of an unidentified nature.
Results and discussion.
The average age of the patients was 4 ± 3.65 years. The fact of ingestion of a foreign body was revealed in the anamnesis in 46 (60.5%) cases. Mental illnesses were diagnosed in 4 children – 5.3%, which is higher than the average in the child population. Clinical symptoms were found in 4 (11.8%) children with a single magnetic foreign body and in 33 (78.6%) with multiple. The main diagnostic method was an overview X-ray of the abdominal cavity (70 cases - 92%), which allowed to identify both a foreign body and possible complications (signs of obstruction, free gas in the abdominal cavity). Fibrogastroduodenoscopy was performed in 50 cases (65.8%), of which a foreign body was detected in 34 (68% of all cases), including in 28 cases the foreign body was removed. Other diagnostic methods (ultrasound, spiral computed tomography) were used much less frequently. Among the treatment methods, open types of surgical intervention prevailed – 32 cases (42%). Laparoscopy was used in isolated cases.
Conclusion.
Magnetic foreign bodies are the most difficult category of foreign bodies, both in terms of diagnosis and treatment. Diagnosis often depends on anamnesis data and, in its absence, is often delayed, and the frequency of intraoperative diagnosis remains high. Among the diagnostic methods, it is difficult to identify a universal one that can be recommended as the "gold standard", however, the most widely used and practical informative is an overview radiograph of the abdominal cavity and FGDS. Among the methods of surgical treatment, the role of laparoscopic technologies is relatively small, endoscopic removal is mainly performed, or "open" surgery is used.
