Magnetic foreign body ingestion in pediatric patients: report of three cases

Abstract

Background: Although foreign bodies (FBs) typically pass spontaneously and uneventfully through the digestive tract, a subset of such bodies may become trapped, eventually leading to significant injury. In particular, the ingestion of magnetic materials can cause serious morbidity due to proximate attraction through the intestinal wall. Case presentation: We recently treated three pediatric patients who had ingested several magnetic foreign materials. None of these patients exhibited any clinical symptoms or signs suggestive of surgical abdomen. Moreover, it was difficult to determine a definite diagnosis and a treatment plan due to limitations in history taking and radiologic examination. After admission to the hospital, these patients underwent surgery for the following reasons: (1) failure to spontaneously pass ingested foreign materials; (2) sudden-onset abdominal pain and vomiting during hospitalization; and (3) gastric perforation incidentally discovered during gastroduodenoscopy. Subsequently, all patients were discharged without complications; however, their conditions might have been fatal without surgery at an appropriate time. Conclusions: As the clear identification about the number and characteristics of ingested magnets via radiographic examination or patient history appears to be difficult in pediatric patients, close inpatient observation would be required in any case of undetermined metallic FB ingestion. Patients who are confirmed to have ingested multiple magnets should be regarded as conditional surgical patients, although their clinical conditions are stable.

Removal of Ingested Magnetic Bodies via Laparoscopic Appendectomy

“…However, none of the patients experienced a sudden abdominal emergency requiring an acute operation. 4 The specific properties of MFBs, the increasing incidence of their ingestion and possible serious complications have contributed to the creation a separate care algorithm. This algorithm was published by Sola et al in 2018 and suggested that the most endangered group of patients are those who swallow multiple MFBs or have a combination with of other magnetizable objects that should be observed during a hospitalization with repeated clinical and X-ray examinations followed by an endoscopic and/or surgical intervention.…”

Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China.

“…1) which was based on the guidelines and the actual experiences at our center. For patients with perforation and stula found after endoscopic removal, the general treatment is to switch to surgery 14 . However, one patient in this study had a stula from the lower esophagus to the cardia.…”

Ileocecal Fistula Caused by Multiple Foreign Magnetic Bodies Ingestion

“…In a report, delayed diagnosis (longer than two days from ingestion) and treatment were related with a worse outcome [ 5 ]. The symptoms usually appear between 1 and 7 days after ingestion [ 12 ], but some authors reported delayed diagnosis of ingested foreign body in a child with intermittent abdominal pain of 6 months [ 13 ].…”

“…During the last decade, powerful and small rare-earth magnets have been manufactured and incorporated into toys, thus increasing the risk of ingestion of dangerous material [ 4 ]. Most of FBs pass through the gastrointestinal tract uneventfully; however, in rare cases, their shape and size can cause complications such as obstruction, ischemia, perforation, or fistula [ 5 ]. Endoscopic intervention is required in 10–20% of patients, while only 1% of patients need urgent surgical approach [ 6 ].…”