Management of Ingested Magnets in Children

Abstract

We describe a comprehensive algorithm for the management of ingested rare-earth magnets in children. These newer and smaller neodymium magnets sold as adult toys are much stronger than the traditional magnets, and can attract each other with formidable forces. If >1 magnet is swallowed at the same time, or a magnet is co-ingested with another metallic object, the loops of intestine can be squeezed between them resulting in bowel damage including perforations. An algorithm that uses the number of magnets ingested, location of magnets, and the timing of ingestion before intervention helps to delineate the roles of the pediatric gastroenterologists and surgeons in the management of these cases.

Perils in the playpen: Duodenojejunal fistula in a child following ingestion of two toy magnets

“…MRI of the abdomen should never be used as it can precipitate a perforation 1 . Modern NIB (alloy of Neodymium, Iron and Boron 7 ) toy magnets are 10 times more powerful than traditional magnets 8 capable of producing attractive forces up to 1300 G. 9 These have been known to erode through the intervening bowel wall resulting in perforation, internal enteric fistulae, internal herniation, adhesions, volvulus, obstruction 2 , mesenteric hemorrhage 4 and death 3 . Enteric fistulae reported are jejunoileal, jejuno-caecal, jejuno-colic and ileo-ileal.…”

Magnet ingestion by a 3-year-old boy

“…Single magnets are of least concern and generally require only close monitoring, prevention of further ingestions, parental education and the avoidance of extrinsic metallic or magnetic objects. 7 When multiple foreign bodies are seen, management is more complicated. If, on serial imaging, the magnets appear to be bound together and mobile, they should be expected to pass together as a unit.…”

“…In response to this challenge, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition published an algorithm addressing the complexity of managing ingested magnets (Appendix 1, available at www .cmaj.ca /lookup /suppl /doi:10.1503 /cmaj .121847 /-/DC1). 7 It stresses the importance of close clinical monitoring; the increased use of plain radiographic imaging; and the collaboration of primary care physicians, gastroenterologists and surgeons.…”

“…7 As medical management, polyethylene glycol 3350 can be used to aid passage. Should these methods fail, surgical removal is required.…”

Multiple Intestinal Perforation and Necrosis due to Magnet Ingestion

“…Among the foreign bodies swallowed, multiple magnets are very rare. However, swallowing multiple magnets may have dire consequences such as intestinal obstruction and intestinal necrosis resulting in perforation and peritonitis [2]. In the presence of symptoms such as abdominal pain, vomiting, or fever, surgical assessment is indicated immediately [3].…”