Rare-Earth Magnet Ingestion–Related Injuries in the Pediatric Population: A Review

Abstract

We would like to present a 6-week-old infant who presented with vomiting, refusal to eat and a distended abdomen for a few hours. Examination showed a distended, tympanic abdomen, with few to no abdominal sounds. Plain abdominal radiograph (Fig. 1) showed a 'coffee-bean' sign with air-fluid levels, confirming a sigmoid volvulus. A colonoscopy using a standard paediatric gastroscope was performed. Under direct endoscopic observation, the first whirl sign could be passed easily with subsequent aspiration of the air and fluid from within the loop. Because the second whirl sign could not be passed, the straightening, clockwise derotation manoeuver was performed just proximal to this. A drainage tube was left in place to prevent recurrence. As the infant had never passed stools spontaneously (after evacuation of meconium within 24 h after birth), anal manome-try was performed and rectal biopsies were taken. These were both suggestive for Hirschsprung's disease. Resection of the agan-glionic segment of the colon with primary anastomosis was performed a couple of weeks later. A recent case series showed endoscopic detorsion (common practice in adults) to be a successful first-line treatment option in children as well. 1 To our knowledge, this is the first report of endoscopic reduction in an infant; previous reports in neo-nates all reported spontaneous, radiological or surgical resolution. 2-4 Our non-surgical approach has the additional advantage to allow sigmoidectomy (which is often needed to prevent recurrence) in a non-inflamed situation with primary anastomosis, after completing the diagnostic work-up that should be done to exclude underlying conditions such as Hirschsprung's disease. Since a certain level of expertise and a paediatric gastroscope are needed for this endoscopic detorsion in an unwell infant, a transfer to a tertiary centre might be required.

Multicenter investigation of pediatric gastrointestinal tract magnets ingestion in China

“…Secondly, on the production level, a national policy should be implemented, targeted towards pediatric toy productions. The magnetic toy size should be enlarged and the material used to make such toys should either revert back to the ordinary magnet that has low magnetic energy product [24] or use a magnetic force lowered to the flux index of 50 kG2 [12]. Warning labels should be much more prominent.…”

“…Warning labels should be much more prominent. Thirdly, on the consumer level, parents and caregivers should be made aware about the potential risk of the toy [11,17,24]; and children younger than 14 years old or who have psychological disorders and pica should refrain from playing with it. Parents should monitor their children more closely when playing with magnetic toys and also educate them about the right way to play with such toys [4,7].…”

Retrospective Analysis of Pediatric Patients with Multiple Rare-Earth Magnet Ingestion: A Single-Center Experience from China.

“…The magnetic force of the rare-earth magnet is 30-50 times stronger than that of the ordinary magnet and each rare-earth magnet can attract 640 times the weight of its own. After multiple rare-earth magnets were swallowed, they attracted each other tightly, resulting in local compression of the intestinal wall, ischemia, necrosis, perforation, internal stula, peritonitis, intestinal obstruction and even death 8 . Rareearth magnets in toys that children swallowed are generally small, and the perforation caused by them is also small.…”

“…For patients considering a single magnet swallowed, follow-up observation is also necessary. If the magnet position is xed, the necessary intervention should be done 8 .…”

Multicenter investigation of pediatric alimentary tract magnets ingestion in China

“…Warning labels should be much more prominent. Thirdly, on the consumer level, parents and caregivers should be made aware about the potential risk of the toy [11,19,24]; and children younger than 14 years old or who have psychological disorders and allotriophagia should refrain from playing with it. Parents should monitor their children more closely when playing with magnetic toys and also educate them about the right way to play with such toys [4,25].…”