Pediatric Multiple High-Powered Magnetic Buckyballs Ingestion—Experience From Six Tertiary Medical Centers

Abstract

Multiple high-powered magnetic Buckyball ingestions may lead to a high risk of severe complications. Great concerns have been raised by public health workers, and it remains challenging for clinicians to solve this troublesome problem. We report a large case series of children with Buckyball ingestion from six tertiary medical centers. The clinical data, including demographics, medical history, diagnosis tools, management options, intraoperative or endoscopic findings, and outcomes, were retrospectively analyzed. Seventy-one children aged 1–13 years ingested 2–41 Buckyballs. Among them, Buckyballs passed spontaneously on 2–10 days post-ingestion in seven cases; gastroscopic removal was performed in 14 cases; laparoscopic removal in 13 cases; laparoscopic-assisted surgical removal in 6 cases; and open surgical removal in 31 cases. Surgical indications included small bowel obstruction, perforation, peritonitis, acute abdominal pain, or along with ingestion of other metallic foreign bodies. Among those who underwent a surgical procedure, primary intestinal repair was performed in 44 cases, enterectomy with primary anastomosis in 6 cases. The postoperative hospital stay ranged from 5 to 28 days. No major complications occurred. In unwitnessed cases, a vague medical history and nonspecific symptoms usually make the diagnosis difficult. The treatment options should include the watch-and-wait approach, endoscopic, laparoscopic-assisted, or open surgical removal of Buckyballs, with primary intestinal repair or anastomosis. Preventive measures, including children's not having access to Buckyballs, are essential to protect children from this kind of unintentional injury.

Surgical treatment of multiple magnet ingestion by children: A single-center experience from China

“… 1 Nonetheless, its diagnostic precision is dependable upon the expertise and experience of the physician. 15 CT imaging has the capability to identify intestinal obstruction, perforation, abdominal inflammation, and other associated complications. However, the contentious aspect surrounding CT employment in the diagnosis of digestive tract foreign bodies stems from its considerable cost.…”

“… 9 Such surgical procedures predominantly encompass laparoscopic surgery and laparotomy. 15 , 16 The former is the traditional surgical approach, suitable for all gastrointestinal foreign bodies. The latter, as indicated by Cai DT et al, can be employed for managing patients who have ingested foreign bodies for more than 2 weeks and exhibit milder clinical symptoms and signs, with the foreign body located in the small intestine.…”

“… 9 , 19 This entails the administration of laxatives and the acquisition of sequential plain radiographs to monitor magnet movement while awaiting natural passage. Consequently, drawing upon the existing body of literature alongside our own clinical experiences, 15 , 20 - 26 a flow chart was introduced for the management of multiple magnetic ingestions in the pediatric population ( Figure 7 ).…”

Removal of Multiple Ingested Magnets Through Laparoscopic Appendectomy in an Adolescent: A Report of Two Cases

“…Since both patients had histories of prolonged observation of not moving magnets, low-dose CTs were performed to exclude extra lumen location of objects or further damage to surrounding organs. Ultrasound is a safe and accurate noninvasive modality used to determine the magnet location [ 6 ]. However, those examinations were inconclusive in our cases.…”

“…Intervals between the ingestion of each magnet may result in locating them in different segments of the intestine. As the ingestion regards high-power magnets, their attractive forces can lead them to merge even through several bowel loops, causing perforations, necrosis, or fistulas [ 6 ]. Hussain et al observed gastric ulceration during the endoscopic removal of multiple magnets less than 8 hours after swallowing, emphasizing the harmful effects on the upper GI tract [ 14 ].…”