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Wang X, Liu H, Gu Z, Lin K, Cheng W, Wang L, Zhang H. Unanticipated gastroduodenal fistula induced by multiple magnetic beads: successful endoscopic management without the need for surgery. Endoscopy 2025; 57:E325-E326. [PMID: 40245944 PMCID: PMC12020656 DOI: 10.1055/a-2578-2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2025]
Affiliation(s)
- Xing Wang
- Department of Digestive Endoscopy Center, Shanghai Childrenʼs Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haifeng Liu
- Department of Digestive Endoscopy Center, Shanghai Childrenʼs Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhujun Gu
- Department of Digestive Endoscopy Center, Shanghai Childrenʼs Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kai Lin
- Department of Digestive Endoscopy Center, Shanghai Childrenʼs Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiwei Cheng
- Department of Digestive Endoscopy Center, Shanghai Childrenʼs Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ling Wang
- Department of Digestive Endoscopy Center, Shanghai Childrenʼs Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haijun Zhang
- Department of Digestive Endoscopy Center, Shanghai Childrenʼs Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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2
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Wan Q, Jiang W, Wang Y, Zhang W, Xu Y, Xu W, An N, Su L, Liu W, Li X. Magnetic Bead Ingestion in a Pediatric Patient: Imaging and Management. J Am Coll Emerg Physicians Open 2025; 6:100109. [PMID: 40242406 PMCID: PMC12002816 DOI: 10.1016/j.acepjo.2025.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Accepted: 02/28/2025] [Indexed: 04/18/2025] Open
Affiliation(s)
- Qing Wan
- Emergency Department, Shanghai United Family Hospital, Shanghai, China
| | - Weiwei Jiang
- Emergency Department, Shanghai SinoUnited Hospital, Shanghai, China
| | - Yiyun Wang
- Emergency Department, Shanghai United Family Hospital, Shanghai, China
| | - Weiyue Zhang
- Emergency Department, Shanghai United Family Hospital, Shanghai, China
| | - Yi Xu
- Emergency Department, Shanghai United Family Hospital, Shanghai, China
| | - Wenpeng Xu
- Emergency Department, Shanghai United Family Hospital, Shanghai, China
| | - Na An
- Emergency Department, Shanghai United Family Hospital, Shanghai, China
| | - Lin Su
- Pediatric Department, Shanghai United Family Hospital, Shanghai, China
| | - Wei Liu
- Radiology Department, Shanghai United Family Hospital, Shanghai, China
| | - Xiaoguang Li
- Emergency Department, Shanghai United Family Hospital, Shanghai, China
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3
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Baindur AJ, Gupta PK, Khare AK. Magnetic beads masquerading as a bracelet causing ileal volvulus with multiple ileoileal fistulae in a child: A case report with systematic literature review. Trop Doct 2025; 55:155-160. [PMID: 40096102 DOI: 10.1177/00494755251328480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
Multiple magnetic foreign body ingestion can cause serious complications in children. Such events are now more frequently seen. We report such a case and present a systematic review to identify the variety of fistulae thereby caused. Timely diagnosis through radiographic imaging plays a pivotal role in guiding clinical decisions.
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Affiliation(s)
- Aditya J Baindur
- Sawai Man Singh Medical college and SPINPH, Jaipur, Rajasthan, India
| | - Pradeep K Gupta
- Sawai Man Singh Medical college and SPINPH, Jaipur, Rajasthan, India
| | - Atul Kumar Khare
- Sawai Man Singh Medical college and SPINPH, Jaipur, Rajasthan, India
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Sodagum L, Truche P, Burjonrappa S. "Signet Ring Sign" on Plain X-ray Indicates the Need for Surgical Intervention After Magnet Ingestion in Children. Cureus 2024; 16:e65943. [PMID: 39221342 PMCID: PMC11365453 DOI: 10.7759/cureus.65943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
The ingestion of magnets used in toys and household products is a common problem in children and can have potentially devastating health consequences. The attraction between multiple magnets across intestinal walls can lead to bowel obstruction, fistula formation, necrosis, and perforation of the involved segments. Multiple magnets attached to each other within the intestinal lumen can also pass spontaneously. Clinical and radiological findings help guide the clinician in deciding whether to intervene surgically or follow an expectant management plan. We report the radiological finding of a "signet ring" on a plain abdominal X-ray that was associated with the surgical finding of fistula formation in two patients, who had clinically benign exams after magnet ingestion. This finding on plain abdominal X-rays should warrant operative exploration in children after magnet ingestion.
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Affiliation(s)
- Lohit Sodagum
- Pediatric Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Paul Truche
- Pediatric Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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Powers K, Baldassari C, Lucas J. Pediatric Esophageal Foreign Bodies and Caustic Ingestions. Otolaryngol Clin North Am 2024; 57:623-633. [PMID: 38519292 DOI: 10.1016/j.otc.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Foreign body ingestions commonly occur in children aged under 6 years. While serious complications of ingestions are rare, sharp objects, caustics, multiple magnets, and button batteries can be associated with poorer outcomes including gastrointestinal (GI) obstruction, perforation, necrosis, and fistula formation. Initial workup should include history, physical examination, and plain film radiographs that will identify radiopaque objects. Removal of the foreign body is typically warranted if the object is high risk, it is located higher up in the GI tract, the patient is symptomatic, or the object is retained for a prolonged amount of time.
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Affiliation(s)
- Kristina Powers
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Cristina Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - Jordyn Lucas
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA, USA.
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6
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Hayward RK, Saxena AK. Surgical management of pediatric multiple magnet ingestions in the past two decades of minimal access surgery- systematic review of operative approaches. Updates Surg 2024; 76:1203-1211. [PMID: 38310610 DOI: 10.1007/s13304-023-01750-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Multiple magnet ingestion is increasingly reported in paediatrics and can cause significant morbidity. Various surgical approaches exist, though minimal literature compares outcomes between techniques. This review evaluates laparoscopic, laparoscopic-assisted, and open surgery with regard to outcomes. METHOD Systematic review across MEDLINE, Embase, Scopus, and Web of Science identified reports of paediatric multiple magnet ingestion managed surgically between 2002 and 2022. RESULTS Ninety-nine studies were included, reporting data from 136 cases. Of these, 82 (60%) underwent laparotomy, 43 (32%) laparoscopic surgery, and 11 (8%) laparoscopic-assisted procedures. Sixteen laparoscopic cases were converted to open, often due to intraoperative findings including necrosis/perforation, or grossly dilated bowel. Bowel perforation occurred in 108 (79%); 47 (35%) required bowel resection, and 3 had temporary stoma formation. Postoperative recovery was uneventful in 118 (86%). Complications were reported following 15 (18%) open and 3 (7%) laparoscopic surgeries. No complications occurred following laparoscopic-assisted surgery. All post-laparoscopic complications were Clavien-Dindo (CD) Grade I. Following open surgery, 5 complications were CD grade I, 6 were CD grade II, and 4 were CD grade IIIb, requiring re-laparotomy. Median length of stay for open and laparoscopic-assisted procedures was 7 days, and for laparoscopic was 5 days (p < 0.001). CONCLUSION Surgical management of multiple magnet ingestion often achieved uncomplicated recovery and no long-term sequelae. Whilst open laparotomy was the more common approach, laparoscopic surgery was associated with reduced length of stay and postoperative complications. Therefore, in experienced hands, laparoscopic surgery should be considered first-line, with the possibility of conversion to open if required.
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Affiliation(s)
- Romilly K Hayward
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK
| | - Amulya K Saxena
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.
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Schaffer O, Kenoshi A, Zmora O. Early colonic-preparation and salvage laparoscopic appendectomy (ECSLA)- innovative protocol for the management of magnets ingestion. Int J Emerg Med 2024; 17:88. [PMID: 39009975 PMCID: PMC11247818 DOI: 10.1186/s12245-024-00678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Ingestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity. METHODS The Early Colonic-preparation and Salvage Laparoscopic Appendectomy (ECSLA) protocol includes initiating colonoscopy preparation upon admission in asymptomatic patients if magnets are not amenable to removal by gastroscopy, and laparoscopic magnets retrieval via appendectomy if surgery is eventually needed. The protocol was initiated in May 2023. A retrospective study of all cases of ingested magnets in children in our institution during July 2020 - January 2024 was conducted to retrieve and analyze demographic, clinical, imaging, management, and outcome data. RESULTS During the 3.5-year study period, 13 cases of ingested multiple magnets were treated, including 7 cases since initiation of ECLSA protocol, with no complications. Since initiation of ECSLA protocol, Early colonic preparation resulted in spontaneous passage of magnets (two cases) and successful colonocsopic removal (three cases), with two cases in which magnets were retrieved via gastroscopy upon admission, and no patients needing surgical intervention. Length of stay (LOS) was short (1-3 days). CONCLUSIONS The ECSLA protocol is a promising tool for preventing surgical intervention and complications and for possibly shortening LOS in children who have ingested multiple magnets.
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Affiliation(s)
- Ortal Schaffer
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Kenoshi
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Zmora
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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8
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Peyron PA, Villard C, Baccino E. Fatal bowel perforation caused by ingestion of high-powered magnets in a 6-year-old boy. Int J Legal Med 2024; 138:1659-1662. [PMID: 38368279 DOI: 10.1007/s00414-024-03188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
Foreign body ingestion in children is a frequent cause for medical consultation. Although most foreign bodies are spontaneously eliminated from the gastrointestinal tract, life-threatening complications such as gastrointestinal obstruction or perforation can occur. We report the case of a 6-year-old boy who died 2 days after the onset of nausea and abdominal pain, with no foreign body ingestion witnessed or reported in the previous days. Autopsy showed a diffuse peritonitis and a perforation of the transverse colon caused by three high-powered magnets stacked together, and attached to the outer stomach wall via a fourth magnet located in the stomach. The cause of death was peritonitis due to bowel perforation by ingested magnets, which were shown to have come from a toy belonging to the child. Ingestion of multiple high-powered magnets carries a high risk of gastrointestinal complications and can exceptionally have a fatal outcome, especially as it often goes unreported and causes non-specific gastrointestinal symptoms that can delay diagnosis and management. This case highlights the need to raise public awareness of the potential risks of ingesting such magnets and to strengthen safety standards to protect children from this serious health hazard.
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Affiliation(s)
- Pierre-Antoine Peyron
- Département de Médecine Légale, CHU Montpellier, Université de Montpellier, Montpellier, France.
| | - Claire Villard
- Département de Médecine Légale, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Eric Baccino
- Département de Médecine Légale, CHU Montpellier, Université de Montpellier, Montpellier, France
- EDPFM, UR-UM212, Université de Montpellier, Montpellier, France
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9
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Kennedy JM, Kumta NA, Lai J. Successful endoscopic removal of high-power magnetic balls embedded in the duodenal wall. JPGN REPORTS 2024; 5:182-185. [PMID: 38756134 PMCID: PMC11093918 DOI: 10.1002/jpr3.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/28/2023] [Accepted: 02/06/2024] [Indexed: 05/18/2024]
Abstract
The dangers of magnet ingestion are well known. When multiple magnets are ingested, interventional removal is often necessary to prevent and/or treat complications. Despite reports of both endoscopic and surgical techniques in the literature, there is a lack of clear guidance on the best method for removal of high-power magnets when they are embedded within the intestinal wall (increasing concern for fistulation, perforation, and bowel wall necrosis). This case demonstrates the successful endoscopic removal of magnetic balls incidentally identified on X-ray and found to be embedded in the duodenal wall in a critically ill 2-year-old patient. Endoscopic removal can be considered in similar situations, if all resources (interventional endoscopy and pediatric surgery) are available to proceed safely.
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Affiliation(s)
| | - Nikhil A. Kumta
- Icahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Joanne Lai
- Icahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
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Tanure DC, Cheib Silva Moreira L, Tanure JC, Rezende-Neto J, Rebouças RLA. Pediatric ingestion of multiple ball magnets leading to intestinal perforation: A case report. Int J Surg Case Rep 2024; 117:109505. [PMID: 38467097 PMCID: PMC10938129 DOI: 10.1016/j.ijscr.2024.109505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Ingestion of foreign bodies is a relatively common cause of abdominal pain in the emergency department among pediatric patients. A less common but potentially life-threatening ingestion is that of magnets. PRESENTATION OF CASE Here, we report the case of a 6-year-old female who ingested 7 ball magnets in a rural town in Brazil and presented with a 4-day history of abdominal pain. Surgical approach was necessary in this case. It consisted of midline laparotomy that revealed one small intestinal perforation of the antimesenteric aspect of the small bowel. The magnets were attached to each other and were retrieved through the perforated intestinal wall. Resection of the necrosed borders of the perforated wall was followed by single-plan extra-mucosal enterorrhaphy of the lesion. CLINICAL DISCUSSION The magnets took on a linear configuration which led to the overlap and obstruction of a loop of the small bowel, with ischemia and perforation of the intestinal wall. CONCLUSION Ingestion of magnets is an unusual event that can lead to increased risks of intestinal mechanical obstruction, and intestinal perforation. Previous research shows that other complications such as fistulas and volvulus can also occur and that patients with this presentation might develop peritonitis, resulting in death if not timely treated.
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Affiliation(s)
- Daniel Capdeville Tanure
- Hospital Sao Vicente de Paulo de Aracuaí, Av. Amazonas 255, Aracuai, Minas Gerais Zip code 39600-000, Brazil.
| | - Laura Cheib Silva Moreira
- Hospital Sao Vicente de Paulo de Aracuaí, Av. Amazonas 255, Aracuai, Minas Gerais Zip code 39600-000, Brazil
| | - Jansen Cherfani Tanure
- Hospital Sao Vicente de Paulo de Aracuaí, Av. Amazonas 255, Aracuai, Minas Gerais Zip code 39600-000, Brazil; Universidade Federal de Minas Gerais, Av. Alfredo Balena 190, Belo Horizonte, Minas Gerais Zip code 30130-100, Brazil
| | - Joao Rezende-Neto
- Trauma and Acute Care Surgery, St. Michael's Hospital, Department of Surgery, University of Toronto, 36 Queen St E, Toronto, ON M5B 1W8, Canada
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Gizewska-Kacprzak K, Nicieja K, Gajek B, Babiak-Choroszczak L. Removal of Multiple Ingested Magnets Through Laparoscopic Appendectomy in an Adolescent: A Report of Two Cases. Cureus 2024; 16:e58825. [PMID: 38654962 PMCID: PMC11037925 DOI: 10.7759/cureus.58825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 04/26/2024] Open
Abstract
Magnet ingestion can lead to serious health issues, including inflammation, gastrointestinal tract perforation, and even life-threatening complications. Despite legislative actions and numerous reports on the dangers of magnet ingestion in children, it remains a significant public health concern. Physicians must remain vigilant in cases of acute abdomen with ambiguous symptoms or unclear history in young patients. Prompt diagnosis and surgical intervention in case of multiple magnet swallowing are crucial to prevent complications. We present two cases of successful removal of ingested magnetic spheres through laparoscopic appendectomy in adolescents. This study aimed to highlight the technical aspects of the procedure to share the benefits of minimally invasive surgery (MIS) in the management of magnetic foreign bodies (FBs) located in the appendix or cecum.
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Affiliation(s)
- Kaja Gizewska-Kacprzak
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Karol Nicieja
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Bartosz Gajek
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Lidia Babiak-Choroszczak
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
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12
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Ibrahim AF, Hussen MS, Tekle Y, Mohammed H. A rare case of cecal foreign body leading to cecal perforation in 12-year-old child: a clinical case report and review of literature. Ann Med Surg (Lond) 2024; 86:1676-1680. [PMID: 38463046 PMCID: PMC10923311 DOI: 10.1097/ms9.0000000000001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/26/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Cecal foreign bodies are uncommon causes of acute abdomen, and their presentation can often mimic acute appendicitis (AA), making it challenging to diagnose. The authors present the case of a 12-year-old male from Ethiopia who initially presented with symptoms suggestive of AA. However, during surgery, the authors found a multiple magnetic fields result in perforation. This case highlights the importance of considering unusual etiologies. Case presentation A 12-year-old boy with AA associated with anorexia, nausea, and low-grade fever was referred from a private clinic. Otherwise, no history of recent respiratory infection and diarrhea, and was previously in good health. The patient did not report any history of a foreign body (FB), even to his own family, and, except for himself, no one was aware of the ingested FB. The work has been reported in line with the Surgical CAse REport (SCARE) 2023 criteria. Discussion In this case, the authors experienced multiple magnetic FB in the cecum, which were not observed on ultrasound (U/S). However, this case closely resembled appendicitis. U/S can aid in differentiation. However, it may not always identify the underlying etiology, specifically in a resource-limited setting. Conclusion Based on the patient's presentation, AA was diagnosed and emergency surgery was presumed to be inflamed. However, three magnetic FB were the underlying cause of the presentation, which created pressure on the cecal wall, and the authors successfully performed surgical management. This case reminds us of uncommon etiologies, such as magnets in patients with symptoms of appendicitis. This underscores the importance of an open-minded approach to unexpected findings during surgery.
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Affiliation(s)
| | | | | | - Hussen Mohammed
- School of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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Alansari AN, Baykuziyev T, Soyer T, Akıncı SM, Al Ali KK, Aljneibi A, Alyasi NH, Afzal M, Ksia A. Magnet ingestion in growing children: a multi-center observational study on single and multiple magnet incidents. Sci Rep 2024; 14:4575. [PMID: 38403623 PMCID: PMC10894856 DOI: 10.1038/s41598-024-55127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024] Open
Abstract
Over the past 15 years, there has been a noticeable uptick in incidents involving children ingesting multiple magnetic foreign bodies which can cause injuries and gastrointestinal complications including death. The current study aimed to identify the prevalence, clinical presentation, and management of single or multiple magnet ingestions. A retrospective multi-central cross-sectional study was conducted to include all pediatric patients < 18 years presented to the emergency department with ingestion of single or multiple magnets and admitted across hospitals in Qatar, UAE, KSA, Tunisia, and Turkey between January 2011 and December 2021. Demographics, symptoms, management, and outcomes were analyzed. There were 189 magnet ingestions, of which 88 (46.6%) were multiple magnet ingestions. Most patients (55.6%) were male, and the median age was 3.9 (IQR 2-7) years. An abdominal X-ray was obtained in all cases. 119 (62%) patients were conservatively treated, 53 (28%) required surgical intervention and 17 (8.9%) underwent gastroscopy. None of the patients with single magnet ingestions experienced morbidity or severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations, perforations (44.3%), severe intestinal necrosis (19.3%), peritonitis (13.6%), severe abdominal infection (10.2%), and septic shock (4.5%). The rate of surgical intervention (59.1% vs. 1.0%) and gastroscopy (15.9% vs. 3.0%) was significantly higher in the multiple ingestion group compared to the single magnet ingestion group. No deaths were identified. A high risk of serious complications, including the need for surgery to remove the magnets and substantial morbidity may result from swallowing more than one magnet. Magnet safety requirements, public education, and improved legislation are urgently required.
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Affiliation(s)
- Amani N Alansari
- Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar.
| | - Temur Baykuziyev
- Department of Anesthesiology, ICU and Perioperative Medicine, Hamad General Hospital, Doha, Qatar
| | - Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Servet Melike Akıncı
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Khalid Khalfan Al Ali
- Department of Pediatric Surgery, Al Qassimi Women and Children's Hospital, Sharjah, United Arab Emirates
| | - Adel Aljneibi
- Department of Pediatric Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Nafea Hussain Alyasi
- Department of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Muhammad Afzal
- Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Kingdom of Saudi Arabia
| | - Amine Ksia
- Department of Pediatric Surgery, Faculty of Medicine, Fattouma Bourguiba Hospital, Monastir, Tunisia
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14
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Nguyen TAT, Calello DP, Ruck B, Loughran DE, Greller HA, Meaden CW. Management patterns of multiple magnet ingestion reported to New Jersey Poison Information and Education System. J Pediatr Gastroenterol Nutr 2024; 78:374-380. [PMID: 38374556 DOI: 10.1002/jpn3.12097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Ingestion of multiple high-powered neodymium rare-earth magnets poses a significant risk for gastrointestinal (GI) injury such as bowel perforation or ischemia. Given the rising incidence of rare earth magnetic ingestions and the corresponding increase in serious injuries in children, published guidelines recommend urgent endoscopic removal of all magnets within endoscopic reach in cases involving ingestions of two or more magnets. RESEARCH QUESTION Do management patterns for multiple magnet ingestion align with current practice guidelines, and does hospital length of stay (LOS) differ based on the initial emergency department (ED) approach? METHODS This is a retrospective chart review of consecutive patient encounters reported to the New Jersey Poison Information and Education System (NJPIES) between January 2021 and April 2022 involving multiple magnet ingestion. Potential cases were retrieved from the NJPIES TOXICALL® database, using substance codes relating to magnet or foreign body ingestion. Two-sample T tests were used to determine the statistical difference in the hospital LOS between the group of patients receiving early emergent esophagogastroduodenoscopy (EGD) versus those receiving expectant management on initial presentation. RESULTS There was a difference in the average LOS of 2.7 days (p = 0.023) longer in the expectant management group with no medical complications in either group. Twenty-five percent or 2 out of 8 cases deviated from guidelines. CONCLUSION The initial ED decision to pursue expectant management instead of attempting emergent EGD removal of magnets may result in prolonged hospitalization, increased risk for readmission, and delayed definitive removal of magnets due to nonprogression along the GI tract.
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Affiliation(s)
- Tuyet-Anh T Nguyen
- Division of Medical Toxicology, Department of Emergency Medicine, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA
| | - Diane P Calello
- Division of Medical Toxicology, Department of Emergency Medicine, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA
- New Jersey Poison Information and Education System, Newark, New Jersey, USA
| | - Bruce Ruck
- Division of Medical Toxicology, Department of Emergency Medicine, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA
- New Jersey Poison Information and Education System, Newark, New Jersey, USA
| | - David E Loughran
- Department of Emergency Medicine, St. Joseph's Medical Center, Stockton, California, USA
| | - Howard A Greller
- Division of Medical Toxicology, Department of Emergency Medicine, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher W Meaden
- Division of Medical Toxicology, Department of Emergency Medicine, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA
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15
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Ignatiev VV, Muraviev AV, Garapov TA, Tishukov MY. [Magnetic foreign bodies of the gastrointestinal tract in pediatric practice]. Khirurgiia (Mosk) 2024:29-37. [PMID: 38477241 DOI: 10.17116/hirurgia202403129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To analyze the pediatric patients with multiple magnetic foreign bodies of the gastrointestinal tract undergoing surgical intervention; to present the treatment and diagnostic algorithm in pediatric practice; to compare surgical interventions for these lesions and determine the most optimal one. MATERIAL AND METHODS A retrospective single-center study included 9 patients diagnosed with multiple magnetic foreign bodies of the gastrointestinal tract. Exclusion criteria: outpatient cases and endoscopic removal of magnetic foreign bodies. All patients underwent laparoscopy and/or laparotomy. We analyzed postoperative data and determined the preferable approach. RESULTS All patients were discharged without complications. Length of hospital-stay was shorter after laparoscopy (7 vs. 12 days). Patients after laparoscopy didn't need for intensive care while laparotomy required ICU stay for 4.5±2.2 days. Enteral feeding started after 1 and 3 days, respectively. CONCLUSION Laparoscopy is preferable for multiple magnetic foreign bodies of the gastrointestinal tract due to shorter hospital-stay, no need for ICU-stay, lower surgical trauma and earlier enteral feeding.
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Affiliation(s)
- V V Ignatiev
- Sevastopol City Hospital No. 5 - Center for Maternal and Child Health, Sevastopol, Russia
| | - A V Muraviev
- Sevastopol City Hospital No. 5 - Center for Maternal and Child Health, Sevastopol, Russia
| | - T A Garapov
- Sevastopol City Hospital No. 5 - Center for Maternal and Child Health, Sevastopol, Russia
- Pirogov Sevastopol City Hospital No. 1, Sevastopol, Russia
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16
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Joo DC, Lee MW, Hong SM, Baek DH, Lee BE, Kim GH, Song GA. A Gastric Magnetic Foreign Body Incidentally Detected Several Years after Ingestion. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 82:198-201. [PMID: 37876260 DOI: 10.4166/kjg.2023.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/26/2023]
Abstract
Foreign body ingestion is commonly seen in children. However, occasionally it may also be seen among adults and is often associated with intellectual disability, psychiatric disorders, and alcoholism. Ingestion of a magnetic foreign body may cause complications such as gastrointestinal tract perforation, wherein emergency endoscopic removal of the foreign body is generally required. Here, we report a rare case of a 59-year-old male with an intellectual disability and psychiatric disorder in whom metallic objects in the stomach cavity were accidentally discovered during abdominal CT. Esophagogastroduodenoscopy revealed several metallic objects attached to two magnets, which had been ingested several years before and had remained in the stomach cavity. The magnets and metallic objects were safely removed endoscopically using rat-tooth forceps without complications.
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Affiliation(s)
- Dong Chan Joo
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Min Hong
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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17
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Maksimyan S, Bernshteyn M, Ravi SJK, Srivatana U. Clinical course and management of an unknown multiple-magnet ingestion in a teenage male. BMJ Case Rep 2023; 16:e256418. [PMID: 37857534 PMCID: PMC10603418 DOI: 10.1136/bcr-2023-256418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Foreign body ingestion in the paediatric population, especially when the details surrounding the ingestion are unknown, can be particularly difficult to manage. Magnets pose a unique challenge, as their magnetic field and caustic properties can instigate significant damage to the gastrointestinal tract if not treated in a timely manner. We report the case of a teenage male who presented to the emergency department with a chief complaint of cramping and abdominal pain. He was found to have multiple metallic foreign bodies within the lumen of the stomach, the distal ileum and the ascending colon/ileocecal valve region, which he did not have any recollection of ingesting. The management of an unknown multiple-magnet ingestion in the older paediatric population is not well documented, and this case may provide unique insight for the management of similar cases.
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Affiliation(s)
- Simona Maksimyan
- College of Medicine, Lake Erie College of Osteopathic Medicine, Elmira, New York, USA
| | | | | | - Ukorn Srivatana
- Gastroenterology, Guthrie Healthcare System, Sayre, Pennsylvania, USA
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18
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Nugud AA, Tzivinikos C, Assa A, Borrelli O, Broekaert I, Martin-de-Carpi J, Deganello Saccomani M, Dolinsek J, Homan M, Mas E, Miele E, Thomson M, Benninga MA. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. J Pediatr Gastroenterol Nutr 2023; 76:523-532. [PMID: 36947000 DOI: 10.1097/mpg.0000000000003702] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Magnet ingestion is a special category of foreign body ingestion associated with high levels of morbidity and mortality worldwide, particularly if it is associated with staggered ingestion of multiple magnets or with simultaneous ingestion of other metallic foreign bodies, especially button batteries. A special category of magnet ingestion is the ingestion of earth magnets, which have higher levels of magnetism and therefore, potentially, carries a worse outcome. Legislative bodies, scientific Societies and community-led initiatives have been implemented worldwide with the aim of mitigating the effects of this growing, yet avoidable potential medical emergency. A scoping literature review summarized epidemiology, diagnosis, management, and prevention, including an algorithm for the diagnosis and management of magnet ingestion is presented and compared to previously published reviews and position papers (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, National Poison Center, Royal College of Emergency Medicine). The main emphasis of the algorithm is on identification of staggered/multiple magnet ingestion, and early joint gastroenterology and surgical consultation and management.
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Affiliation(s)
- A A Nugud
- From the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Christos Tzivinikos
- From the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Amit Assa
- The Juliet Keidan Institute of Pediatric Gastroenterology, Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Osvaldo Borrelli
- the Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Ilse Broekaert
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Jernej Dolinsek
- the Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
| | - M Homan
- the Faculty of Medicine, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Emmanuel Mas
- Service de Gastroentérologie, Hépatologie, Nutrition et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, and IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Erasmo Miele
- the Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Mike Thomson
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc A Benninga
- the Department of Paediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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19
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Ali AA, Dhungana A, Mohamed MKS, Zaadhee A, Rasheed R, Ubaid A, Lee XL, Hayati F, Abd Karim K, Zakaria AD. Magnetic perforation: Why we say NO to kids. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023; 88:102491. [DOI: 10.1016/j.epsc.2022.102491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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20
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Advantages of Fluoroscopy for Accidental Ingestion of Multiple Magnets. Case Rep Pediatr 2023; 2023:1512514. [PMID: 36910864 PMCID: PMC9995182 DOI: 10.1155/2023/1512514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
Foreign body ingestion is one of the common problems among children. A three-year-old girl presented to the emergency department 2 h after ingesting three small disk-type neodymium magnets. She had no gastrointestinal symptoms. Abdominal radiography revealed a foreign body in the left upper quadrant, which was the three circular magnets. Fluoroscopy was performed. She was placed in the right lateral decubitus position for 3 min and slowly returned to the supine position. Abdominal fluoroscopy revealed a foreign body migrating near the middle of the spine. Similarly, when she was placed in the left lateral decubitus position for 3 min and slowly returned to the supine position, the foreign body migrated to the outermost part of her left upper quadrant. Thus, we anticipated that the magnets could be excreted spontaneously. The patient did not develop any gastrointestinal symptoms after returning home, and two days later, three overlapping magnets were finally found in her stool. During accidental ingestion of single or multiple desk-type neodymium magnets, endoscopic removal may not be necessary if they are mobile and clump together in the stomach. Regarding the ingestion of multiple desk-type neodymium magnets, fluoroscopy is useful to determine the extent of endoscopic intervention.
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21
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Guilcher K, Sokollik C. Innovative Makeshift Technique for Removing Ingested Rare Earth Magnets. JPGN REPORTS 2022; 3:e257. [PMID: 37168473 PMCID: PMC10158333 DOI: 10.1097/pg9.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/02/2022] [Indexed: 05/13/2023]
Affiliation(s)
- Katharina Guilcher
- Division of Pediatric Gastroenterology, Hepatology and Nutrition Children’s Hospital, University of Bern Bern, Switzerland
| | - Christiane Sokollik
- Division of Pediatric Gastroenterology, Hepatology and Nutrition Children’s Hospital, University of Bern Bern, Switzerland
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22
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Seguier-Lipszyc E, Samuk I, Almog A, Silbermintz A, Kravarusic D. Multiple magnet ingestion in children: A problem on the rise. J Paediatr Child Health 2022; 58:1824-1828. [PMID: 35841278 DOI: 10.1111/jpc.16117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/12/2022] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
Abstract
AIM Ingestion of multiple magnets is increasing these last 15 years in children. They have resulted in numerous reports of serious gastrointestinal complications such as bowel obstruction, ischaemia, necrosis, perforation and fistula formation and even led to death. The increasing number of world-wide reports of complications secondary to magnet ingestion and a frequently delayed diagnosis point to a lack of awareness about these risks among medical care-givers in our country and parents in general. METHODS We reviewed retrospectively all cases of multiple magnet ingestion that required a gastro-intestinal or surgical procedure for removal from 2009 to 2020. RESULTS Five children underwent gastroscopy removal and three colonoscopy removal of the magnets. Five patients required surgical (laparotomy or laparoscopy) removal of multiple magnets with intestinal perforations. CONCLUSIONS We propose an updated management algorithm for multiple magnet ingestion to highlight awareness among primary physicians and parents of the presenting circumstances and symptoms as well as the potential complications associated with multiple magnet ingestion.
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Affiliation(s)
- Emmanuelle Seguier-Lipszyc
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel.,Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Samuk
- Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Anastasia Almog
- Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ari Silbermintz
- Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Dragan Kravarusic
- Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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23
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Kong X, Wei C. Clinical Features and Management of Urethral Foreign Bodies in Children: A 10-Year Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1468. [PMID: 36291404 PMCID: PMC9600604 DOI: 10.3390/children9101468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Urethral foreign bodies (UFBs) are very rare in children, and their treatment remains challenging. (2) Methods: A retrospective analysis was performed on 40 patients who were admitted to our hospital due to UFBs from June 2011 to June 2021. The clinical features and treatment experiences of these children are summarized. (3) Results: A total of 40 children were enrolled in the study, 17 boys and 23 girls. A majority of the boys (median age: 11.8 years) were of puberal age, and the main cause of the UFBs was sexual gratification (94.1%). Girls were almost always in early childhood (median age: 1.8 years), and most of the UFBs were related to specific clothing in specific regions and seasons. Ultrasound had a high accuracy in the diagnosis of female UFBs; the sensitivity and specificity were 88.9% and 85.7%, respectively. Most UFBs could be removed using a cystoscope (82.4% in boys, 100% in girls). All the children had a good prognosis and no complications occurred during follow-up. (4) Conclusions: Ultrasound is a reliable and sensitive method for the diagnosis of UFBs in girls. Cystoscopy is a reliable surgical method for UFBs.
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Affiliation(s)
- Xiangpan Kong
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Chun Wei
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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24
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da Silva DS, Markus JR, Lopes AB, Sousa LDS, Maciel EDS, do Nascimento LR, Silva LS, Barasuol AM, Pontes-Silva A, Quaresma FRP. Protocol of care for foreign-body ingestion in children: a qualitative study. Rev Assoc Med Bras (1992) 2022; 68:1270-1275. [PMID: 36228258 PMCID: PMC9575034 DOI: 10.1590/1806-9282.20220368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: This study aimed to suggest a care protocol for foreign-body ingestion, address the clinical aspects, and identify the ingested object, severity, and professional conduct. METHODS: This is a qualitative study. We used books and original articles published in national and international journals (BIREME, SCIELO, LILACS, and MEDLINE/PubMed) in Portuguese, Spanish, and English. RESULTS: The ingestion of a radiolucent object should be evaluated radiographically and with endoscopy for cases with symptoms of impaction and radiolucent objects. Coins are the most commonly involved foreign bodies. In asymptomatic patients, it often requires only a conservative form of management. Ingestion of batteries, magnets, and sharp objects carries a high risk of serious clinical complications and should have an endoscopic or surgical approach. In view of this, each pediatric emergency service, based on these recommendations, has the possibility to develop an individual protocol to identify and remove the ingested foreign body. CONCLUSIONS: Protocol of care for foreign-body ingestion in children depends on the object ingested, time of ingestion, symptoms, and local epidemiological context. This study provides some suggestions for decision-making in the conduct of health professionals.
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Affiliation(s)
- Dario Silva da Silva
- Universidade Federal do Tocantins, Postgraduate Program in Science and Health Teaching – Palmas (TO), Brazil
| | | | | | | | - Erika da Silva Maciel
- Universidade Federal do Tocantins, Postgraduate Program in Science and Health Teaching – Palmas (TO), Brazil
| | | | - Luiz Sinésio Silva
- Universidade Federal do Tocantins, Postgraduate Program in Science and Health Teaching – Palmas (TO), Brazil
| | - Aldair Martins Barasuol
- Universidade Federal do Tocantins, Postgraduate Program in Science and Health Teaching – Palmas (TO), Brazil
| | - André Pontes-Silva
- Universidade Federal de São Carlos, Postgraduate Program in Physiotherapy – São Carlos (SP), Brazil.,Universidade Federal do Maranhão, Postgraduate Program in Adult Health – São Luís (MA), Brazil.,Corresponding author:
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25
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Abstract
OBJECTIVES To review the clinical management and outcomes of magnet ingestions at a large tertiary children's hospital. To determine the association of frequency of high-powered magnet ingestion with the regulation of these magnets. METHODS Children <18 years who presented to the emergency room and were admitted to the Children's Hospital of Philadelphia for ingestion of single or multiple magnets from January 2008 to December 2020 were included. Demographics, symptoms, management, and outcomes were analyzed. The frequency of magnet ingestion was compared over 3 eras: (1) pre-ban (2008-2012), (2) intra-ban (2013-2016), and (3) post-ban (2017-2020). RESULTS There were 167 magnet ingestions, including 99 with multiple magnets. Most patients (59%) were male and median age was 6 (interquartile range, 3-9) years. Most single magnet ingestions (86%) were discharged with outpatient monitoring, and none experienced severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations (68%), endoscopic procedures (48%), surgical procedures (14%), and severe outcomes (12%). Most patients (75%) were asymptomatic, however, there was a higher risk of surgery and severe complications based on the presence of symptoms ( P = 0.003). The rate of surgical intervention was higher with ≥3 magnets (31.7%) compared to 2 magnets (2.4%) ( P < 0.003). Additionally, we found an 160% increase in children with magnet ingestions in the post-ban period ( P = 0.021). CONCLUSIONS Multiple magnet ingestion is associated with high morbidity and rate of severe outcomes. There is a relationship between public policy of magnet sale and frequency of magnet ingestion.
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26
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Holtestaul T, Franko J, Escobar MA, Barlow M. Pediatric Ingestions. Surg Clin North Am 2022; 102:779-795. [DOI: 10.1016/j.suc.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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27
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Jin Y, Gao Z, Zhang Y, Cai D, Hu D, Zhang S, Mao J. Management of multiple magnetic foreign body ingestion in pediatric patients. BMC Pediatr 2022; 22:448. [PMID: 35879696 PMCID: PMC9316800 DOI: 10.1186/s12887-022-03501-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background Multiple magnetic foreign body ingestion in children is increasingly common and can cause serious injury. The present study aimed to analyze the clinical features of such cases and summarize treatment experiences. Methods A retrospective survey of 91 patients in the Children’s Hospital, Zhejiang University School of Medicine with magnetic foreign body ingestion from October 2018 to October 2021 was performed, the data were collected including the clinical information of the patients, treatment details, and prognosis. Results Twenty-two (24.2%) patients were conservatively treated, with the foreign bodies discharged through the anus, 31 (34.1%) underwent laparoscopic surgery, including 18 cases converting from laparoscopic surgery to laparotomy, and 38 (41.8%) underwent laparotomy. In 13 (14.3%) patients, the foreign bodies were partially removed by gastroscope. The remaining foreign bodies were removed by laparoscopy in six patients, including three cases converting from laparoscopy to laparotomy, by laparotomy in four patients, and by conservative treatment in three patients. Conclusions Multiple magnetic foreign body ingestion can cause significant harm to patients and different clinical techniques must be used for patients in different situations to reduce the harm to children.
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Affiliation(s)
- Yi Jin
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Zhigang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Yuebin Zhang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Duote Cai
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Di Hu
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Shuhao Zhang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Jianhua Mao
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China.
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28
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Pediatric Foreign Body Ingestion: Complications and Patient and Foreign Body Factors. SCI 2022. [DOI: 10.3390/sci4020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Management of the child who has swallowed a foreign body should be guided by the risk of complication. Objective of the Review: This review discusses the patient and foreign body characteristics most likely to be associated with complications. Discussion: Most swallowed foreign bodies will pass through the GI tract without complication. Children with pre-existing GI tract abnormalities of any sort, or those who swallow higher-risk foreign bodies, are at higher risk. Higher-risk foreign bodies include long, sharp, or pointed objects, button batteries, and small magnets. Nearly any child who presents to an Emergency Department or other acute care setting after foreign body ingestion should undergo plain radiography; other forms of imaging may also be appropriate. Primary care providers may opt for an initial observation period when there is lower risk of complication. Esophageal button batteries should be emergently removed; other esophageal objects should be promptly removed or, if low risk, allowed a brief period to pass spontaneously. Most lower GI tract foreign bodies will pass spontaneously. Prevention, while not always possible, is preferable to management of foreign body ingestion. Conclusions: Management strategies for children who have swallowed foreign bodies can be optimized by considering relevant patient and foreign body factors, and how they contribute to the risk of complication.
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29
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Encisco EM, Gerardo RG, Ponsky TA. High-powered magnets still require high-powered vigilance. J Pediatr Surg 2022; 57:949. [PMID: 35074180 DOI: 10.1016/j.jpedsurg.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ellen M Encisco
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA.
| | - Rodrigo G Gerardo
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Todd A Ponsky
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA
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30
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Chavan R, Bachkaniwala V, Tadkalkar V, Gandhi C, Rajput S. Endoscopic management of magnet ingestion and its adverse events in children. VideoGIE 2022; 7:302-307. [PMID: 36034063 PMCID: PMC9414231 DOI: 10.1016/j.vgie.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and Aims Magnet ingestion has recently increased among children. Multiple magnets can lead to serious adverse events owing to pressure necrosis of trapped bowel wall; therefore, urgent removal of the magnet is recommended. However, awareness of magnet ingestion and adverse events associated with it are lacking among the general population and some healthcare professionals. Herein, we demonstrate the adverse events associated with prolonged retention of ingested magnets and endoscopic management of ingested magnets in children. Methods We present a case series of 3 patients with magnet ingestion. Foreign body ingestion was confirmed on fluoroscopy. After fluoroscopy, all children underwent EGD under propofol sedation in a left lateral position. A Roth net was used to remove magnets. Results Three patients (median age 5 years), each with ingestion of 2 magnets of different shapes and sizes and with variable periods of ingestion, underwent EGD. In 2 patients, both magnets were Successfully removed. In 1 patient, 1 magnet could not be removed because it became dislodged deep in the jejunum. All 3 patients had developed magnet-related fistula (gastroduodenal: 1 patient; duodenojejunal: 2 patients). Patients with duodenojejunal fistula were managed conservatively. There was mild self-limited bleeding during magnet removal in 1 patient. There were no major adverse events related to endoscopic removal. Conclusions Endoscopic removal of magnets is feasible and safe in children. Few patients with fistulas can be managed conservatively. There is an unmet need to increase societal awareness of magnet ingestions and adverse events associated with it.
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Khan A. Nearly missed laryngeal foreign body. J Am Coll Emerg Physicians Open 2022; 3:e12662. [PMID: 35112103 PMCID: PMC8783379 DOI: 10.1002/emp2.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022] Open
Abstract
Foreign body ingestion and aspiration can present as a life-threatening emergency in children. These foreign bodies are diagnosed based on history, physical exam, and focused radiography to reduce the risk of excessive radiation. We describe a case of a 3-year-old child who ingested magnetic beads and presented to the emergency department with no symptoms. On a single view x-ray of chest and abdomen, the magnetic beads were identified in the abdomen but a closer look at these single view x-rays raised a suspicion of additional foreign bodies in the larynx. A dedicated x-ray of the neck identified 2 more magnetic beads locked with each other on either side of the epiglottis. These laryngeal magnetic beads were nearly missed on initial x-rays, especially because the child had no symptoms of upper airway obstruction. This case report provides further evidence that in the evaluation of radiopaque foreign bodies in children we should strongly consider "nose to rectum" x-rays.
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Affiliation(s)
- Abdullah Khan
- Dignity Health ‐ St. Rose Dominican HospitalDepartment of Pediatric Emergency MedicineSiena Campus HospitalHendersonNevadaUSA
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Stephenson SG, Knight CT, Rana HN, Standley T, Figarola S. An Unfortunate Union: A Case of Multiple Magnet Ingestion in a Pediatric Patient. Cureus 2022; 14:e21490. [PMID: 35223268 PMCID: PMC8859820 DOI: 10.7759/cureus.21490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Magnets are among the most dangerous foreign objects that a child can ingest. If more than one magnet is ingested, the attraction between loops of the bowel can bring adjacent loops closer together, leading to perforation, obstruction, or fistulization. Pediatric magnet ingestion patients often require endoscopic or surgical intervention to retrieve the objects and repair the damage created by the magnets. Due to the risks of surgical intervention, management is done with strict adherence to the rare earth magnet ingestion algorithm. We highlighted a pediatric case of multiple magnet ingestion, and the steps that were taken to manage the patient. Our case highlights the potential for complications and the importance of adherence to the management algorithm in these patients. Epidemiology, mechanisms, algorithms, and outcomes for pediatric magnet ingestion patients were discussed.
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Taniguchi M, Hatachi T, Takeuchi M. Gastric perforation in the lesser curvature caused by multiple neodymium magnets. Pediatr Int 2022; 64:e15361. [PMID: 36564345 DOI: 10.1111/ped.15361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/10/2022] [Accepted: 09/20/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Masashi Taniguchi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takeshi Hatachi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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Xin Y, Jia LQ, Dong YW, Wang Y, Hu YX, Wang XM. Application of high-frequency ultrasound in the diagnosis of gastrointestinal magnet ingestion in children. Front Pediatr 2022; 10:988596. [PMID: 36714638 PMCID: PMC9880474 DOI: 10.3389/fped.2022.988596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of magnet ingestion by children has recently increased in China. Magnet ingestion is associated with an extremely high risk of gastrointestinal damage because loops of bowel can become trapped and squeezed between multiple magnets in different locations. However, the lack of imaging sensitivity makes clinical decision-making difficult. OBJECTIVE This study was conducted to investigate the performance of ultrasound in diagnosing gastrointestinal magnet ingestion in children. METHODS From April 2017 to February 2021, all children with a history of magnet ingestion or a diagnosis of gastrointestinal magnet as shown by x-ray or ultrasound in our hospital were included as study candidates. Patients who were lost to follow-up or had known malformations of the gastrointestinal tract were excluded. Eligible patients were those with surgical or endoscopic confirmation of gastrointestinal magnet, those who passed the magnet out of the alimentary tract without assistance, and those with confirmed absence of the magnet on abdominal x-ray examination after 1 month of conservative treatment. All eligible patients' ultrasound and x-ray examination data were evaluated. The sensitivity, specificity, and area under the curve (AUC) of ultrasound was calculated for diagnosing magnet ingestion, locating the magnet (stomach, small intestine, or colon), and confirming the phenomenon of wall entrapment. RESULTS Of 112 patients, 107 had a magnetic foreign body and 5 did not. Magnets were correctly detected by ultrasound in 97 patients, with an observed sensitivity of 90.65% and specificity of 100%. Satisfactory sensitivity was obtained for ultrasound localization of gastric magnets (96.30%) and small intestinal magnets (100.00%), but sensitivity for ultrasound localization of colonic magnets was relatively poor (73.33%). The discrimination of wall entrapment by ultrasound was good (AUC = 0.93), with an observed sensitivity and specificity of 92.00% and 93.62%, respectively. CONCLUSIONS Ultrasound can be used to locate gastrointestinal magnets (in the stomach, small intestine, or colon) with good clinical efficacy in identifying wall entrapment.
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Affiliation(s)
- Yue Xin
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Qun Jia
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ya Wei Dong
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yan Xiu Hu
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiao Man Wang
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Al-Saied G, Alsamahy O, Ibrahim M, Al-Malki T, BenMalek R, Khemakhem R, AlNefaie Z, Hussain T, Shafik Y, Thabet R, Farhan G, Gamal A, Habib SA, Gamal A, Elghazeery M. Enteroenteric fistulae after ingestion of multiple magnets in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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36
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Ibrahim AH, Andijani A, Abdulshakour M, Algain S, Thamrah AA, Ali MM, Marwah H, Aldaher A, Bashir S, Alsaleem B, Asery A, Al-Hussaini A. What Do Saudi Children Ingest?: A 10-Year Retrospective Analysis of Ingested Foreign Bodies From a Tertiary Care Center. Pediatr Emerg Care 2021; 37:e1044-e1050. [PMID: 31348207 PMCID: PMC8667801 DOI: 10.1097/pec.0000000000001894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few studies investigated the correlation between foreign body (FB) ingestion and occurrence of complications. The local literature is limited to case reports and small case series on esophageal FBs. We conducted this study to identify the high-risk factors predisposing to complications among Saudi children ingesting FBs. METHODS The medical records of 436 children (boys, 59.6%; mean age, 4.4 ± 2.7 years) presenting to the emergency department (ED) between 2007 and 2016 were retrospectively reviewed. Relative risk analysis of clinical variables was performed between 2 groups: The first group constituted children without FB-related complications (n = 389), and the second group included those with major complications (n = 14). Major complication was defined as any event associated with significant morbidity such as esophageal stricture, esophageal perforation, esophageal fistula, and intestinal perforation or fistula formation. RESULTS Most of the 436 cases presented between ages 2 and 4 years (35.1%). Coin was the most commonly ingested FB (22.9%) followed by button battery (19.5%). Most of the ingested FBs passed spontaneously without intervention (69%). Upper endoscopy was performed in 121 cases (27.7%). By multivariate analysis, the variables that were significantly associated with major complications included the following: very young age group (0-2 years; odds ratio [OR], 11.5), button battery (OR, 4), FB impacted at upper esophagus (OR, 8.7), and longer time duration to visit the ED (OR, 14.7). CONCLUSION Button battery impaction at upper esophagus in very young children and delayed presentation to the ED were the most significant risk factors of FB-related complications.
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Affiliation(s)
- Ahmed H. Ibrahim
- From the Children’s Specialized Hospital, King Fahad Medical City
| | | | | | - Sulwan Algain
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Asma Abu Thamrah
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Mariam M. Ali
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Haifa Marwah
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Anwaar Aldaher
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Salman Bashir
- Department of Biostatistics, Research Services Administration, Research Center, King Fahad Medical City
| | - Badr Alsaleem
- Division of Pediatric Gastroenterology, Children’s Specialized Hospital, King Fahad Medical City
| | - Ali Asery
- Division of Pediatric Gastroenterology, Children’s Specialized Hospital, King Fahad Medical City
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37
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Falcon AC, Fernández-Valdes L, Iglesias C, Saps M. Magnet ingestion knows no borders: A threat for Latin American children. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:292-296. [PMID: 34794926 DOI: 10.1016/j.rgmxen.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS The ingestion of foreign bodies, such as magnets, is a potentially lethal accident that affects children and is associated with bleeding and gastrointestinal perforation, as well as death. There are no Latin American reports in the literature on cases of magnet ingestion in children. Our aim was to establish whether said ingestion has been seen by pediatric endoscopists and gastroenterologists in Latin America, to determine the scope of that potential threat in their patient populations. MATERIALS AND METHODS We collected data regarding endoscopies performed on children in Latin America, within the time frame of 2017-2019, through questionnaires that were distributed to pediatric endoscopists at the 2nd World Congress of Gastrointestinal Endoscopy (ENDO 2020). The questionnaires provided information on foreign body location, the presence and number of ingested magnets, and the description of complications and surgical interventions. RESULTS Our cohort from 12 Latin American countries reported 2,363 endoscopies due to foreign body ingestion, 25 (1.05%) of which were the result of having swallowed one or more magnets. Mean patient age was 5.14 years (SD 2.5) and 10 (40%) of the cases were girls. Three (12%) of the patients presented with severe complications and 2 (8%) cases required surgery. CONCLUSIONS Our preliminary study suggests that the ingestion of magnets is not common in Latin American countries, but said cases are frequently associated with complications. Constant monitoring of the incidence of such cases is extremely important, so that through education and awareness of those events, life-threatening complications in children can be prevented.
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Affiliation(s)
- A C Falcon
- Departamento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - L Fernández-Valdes
- Departamento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - C Iglesias
- Departamento de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Pereira Rossell, Montevideo, Uruguay
| | - M Saps
- Departamento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, USA.
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38
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Oh RG, Lee CG, Park YN, Lee YM. Successful removal of two magnets in the small intestine by laparoscopy and colonoscopy: A case report. World J Clin Cases 2021; 9:8226-8231. [PMID: 34621885 PMCID: PMC8462221 DOI: 10.12998/wjcc.v9.i27.8226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ingestion of multiple magnets can cause serious gastrointestinal complications, such as obstruction, fistulae, and perforation. When multiple magnets traverse the stomach, coordination between pediatric gastroenterologists and pediatric surgeons is recommended, and ultimate management is required dependent on clinical concerns.
CASE SUMMARY A 5-year-old girl swallowed 2 small magnets that then remained in the right lower quadrant (RLQ) of the abdomen for 3 d; this required endoscopic and laparoscopic intervention. Abdominal X-ray and computed tomography revealed high-density objects in the RLQ area. Colonoscopy after proper bowel preparations on the third day of ingestion revealed no foreign body in the colonic area or the end of the ileum. The two magnets were removed via colonoscopy with laparoscopic intervention.
CONCLUSION It is important to establish effective coordination between pediatric gastroenterologists and pediatric surgeons when using a non-invasive procedure to remove magnets.
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Affiliation(s)
- Ryang Geun Oh
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Cheol Gu Lee
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - You Na Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
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39
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Falcon AC, Fernández-Valdes L, Iglesias C, Saps M. Magnet ingestion knows no borders: A threat for Latin American children. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 87:S0375-0906(21)00074-4. [PMID: 34538505 DOI: 10.1016/j.rgmx.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND AIMS The ingestion of foreign bodies, such as magnets, is a potentially lethal accident that affects children and is associated with bleeding and gastrointestinal perforation, as well as death. There are no Latin American reports in the literature on cases of magnet ingestion in children. Our aim was to establish whether said ingestion has been seen by pediatric endoscopists and gastroenterologists in Latin America, to determine the scope of that potential threat in their patient populations. MATERIALS AND METHODS We collected data regarding endoscopies performed on children in Latin America, within the time frame of 2017-2019, through questionnaires that were distributed to pediatric endoscopists at the 2nd World Congress of Gastrointestinal Endoscopy (ENDO 2020). The questionnaires provided information on foreign body location, the presence and number of ingested magnets, and the description of complications and surgical interventions. RESULTS Our cohort from 12 Latin American countries reported 2,363 endoscopies due to foreign body ingestion, 25 (1.05%) of which were the result of having swallowed one or more magnets. Mean patient age was 5.14years (SD2.5) and 10 (40%) of the cases were girls. Three (12%) of the patients presented with severe complications and 2 (8%) cases required surgery. CONCLUSIONS Our preliminary study suggests that the ingestion of magnets is not common in Latin American countries, but said cases are frequently associated with complications. Constant monitoring of the incidence of such cases is extremely important, so that through education and awareness of those events, life-threatening complications in children can be prevented.
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Affiliation(s)
- A C Falcon
- Departmento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos
| | - L Fernández-Valdes
- Departmento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos
| | - C Iglesias
- Departamento de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Pereira Rossell, Montevideo, Uruguay
| | - M Saps
- Departmento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos.
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40
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Khalaf Z, Al Hindi S, Alsayegh R. Laparoscopic assisted removal of multiple ingested magnetic foreign bodies in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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41
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Dong T, Mo X, Fan Z, Liu L. Endoscopic forceps removal for complicated magnetic beads impaction. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:467-469. [PMID: 33486964 DOI: 10.17235/reed.2021.7731/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 2-year-old girl was transferred to our center after she was witnessed swallowing a magnetic toy two days previously. An abdominal x-ray at a community hospital showed multiple foreign bodies in the gastric region and close observation was advised. However, radiography the next day showed the magnets' persistence in situ.
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Affiliation(s)
- Tao Dong
- Digestive Endoscopy and General Surgery, the First Affiliated Hospital with Nanjing Medical University
| | - Xuming Mo
- Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University
| | - Zhining Fan
- Digestive Endoscopy and General Surgery, The First Affiliated Hospital with Nanjing Medical University
| | - Li Liu
- Digestive Endoscopy and General Surgery, the First Affiliated Hospital with Nanjing Medical University
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Au A, Goldman RD. Management of gastric metallic foreign bodies in children. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:503-505. [PMID: 34261710 DOI: 10.46747/cfp.6707503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
QUESTION A 2-year-old boy presented to my clinic after a caregiver witnessed him swallow a foreign body. The caregiver recalls seeing a small metallic object but is unsure exactly what was ingested. The child was asymptomatic upon examination. How should I identify and localize the foreign body? Do metal foreign bodies need to be removed endoscopically? ANSWER Foreign body ingestion is very common in children. Considerations must be made for the type of foreign body and site of impaction. A clear patient history and radiographs should be used to localize and identify the object. Handheld metal detectors can also be used to localize known metallic foreign bodies. Most metallic objects that pass the esophagus and reach the stomach will continue to pass without complication. Bowel perforation, sepsis, and even death have been documented in extremely rare cases of multiple magnets, button batteries, and long, angular, or 2-pointed sharp objects. These objects must be removed. Other metallic foreign bodies including coins and single magnets can be managed conservatively with stool monitoring.
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Morulana T, Tshifularo N, Ngwenya T, Motloung E. Small bowel fistula caused by ingested magnetic beads. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Luks VL, Agawu A, Schwartz D, Sreedharan RR, Laje P. Magnet Entrapment in the Right Lower Quadrant: A Management Dilemma. Clin Pediatr (Phila) 2021; 60:321-324. [PMID: 33870754 DOI: 10.1177/00099228211008092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Valerie L Luks
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Atu Agawu
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana Schwartz
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Pablo Laje
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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45
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Middelberg LK, Funk AR, Hays HL, McKenzie LB, Rudolph B, Spiller HA. Magnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019. J Pediatr 2021; 232:251-256.e2. [PMID: 33516676 DOI: 10.1016/j.jpeds.2021.01.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine, using the National Poison Data System (the data warehouse for poison control centers in the US), magnet foreign body injuries in pediatric patients. We sought to report demographic data, outcome data, and case trends between 2008 and 2019. STUDY DESIGN We conducted a retrospective analysis of the National Poison Data System for patients younger than 19 years of age with a magnet "exposure," which poison centers define as an ingestion, inhalation, injection, or dermal exposure to a poison. RESULTS A total of 5738 magnet exposures were identified. Most were male (3169; 55%), <6 years old (3572; 62%), with an unintentional injury (4828; 84%). There were 222 patients (3.9%) with a confirmed medical "effect," defined as signs, symptoms, and clinical findings not including therapeutic interventions (eg, endoscopy). There was a 33% decrease in cases from 418 (2008-2011) to 281 per year (2012-2017) after high-powered magnet sets were removed from the market. Calls subsequently increased 444% to 1249 per year (2018-2019) after high-powered magnet sets re-entered the market. Cases from 2018 and 2019 increased across all age groups and account for 39% of magnet cases since 2008. CONCLUSIONS Significant increases in magnet injuries correspond to time periods in which high-powered magnet sets were sold, including a 444% increase since 2018. These results reflect the increased need for preventative or legislative efforts.
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Affiliation(s)
- Leah K Middelberg
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH.
| | - Alexandra R Funk
- Nationwide Children's Hospital, Columbus, OH; Central Ohio Poison Center, Columbus, OH
| | - Hannah L Hays
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Central Ohio Poison Center, Columbus, OH
| | - Lara B McKenzie
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH; Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH
| | - Bryan Rudolph
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Henry A Spiller
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Central Ohio Poison Center, Columbus, OH
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46
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Alkhamisy A. Gastrojejunal fistula caused by magnet beads ingestion in a 2 -year-old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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47
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Su ZL, Liu D, Zhou XH, Tian XE, Shan ZC, Hou SZ. Digestive Tract Injuries Caused by Ingested Foreign Bodies Containing Magnets. Indian Pediatr 2021. [PMID: 33713066 PMCID: PMC8005281 DOI: 10.1007/s13312-021-2171-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on 16 children with ingestion of magnetic foreign bodies, who were identified by a medical record review of our hospital data for the time period between January, 2017 and May, 2018. Digestive tract wall was sandwiched in 13 (75%) children and 11 (74%) had gaptic intestinal perforation.
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Affiliation(s)
- Ze-Li Su
- Department of Pediatric Surgery, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Dong Liu
- Department of Pediatric Surgery, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xue-Hong Zhou
- Department of Pediatric Surgery, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xuan-En Tian
- Department of Pediatric Surgery, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhen-Chao Shan
- Department of Pediatric Surgery, The General Hospital of Ningxia Medical University, Yinchuan, China.
| | - Shao-Zhang Hou
- Department of Pathology, School of Basic Medical Sciences, Ningxia Medical University; Yinchuan, China.
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Zhang S, Zhang L, Chen Q, Zhang Y, Cai D, Luo W, Chen K, Pan T, Gao Z. Management of magnetic foreign body ingestion in children. Medicine (Baltimore) 2021; 100:e24055. [PMID: 33466161 PMCID: PMC7808496 DOI: 10.1097/md.0000000000024055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
Magnetic foreign bodies ingestion is a special cause for attending emergency department. Here, we aim to analyze the characteristics and treatments of children who ingested magnetic foreign bodies (Buckyballs). Data were collected from children who ingested Buckyballs between February 2017 and October 2019. A retrospective analysis was performed to summarize the experiences of conservative treatment, gastroscopy and surgery when dealing with Buckyballs ingestion.A total of 49 patients with buckyballs ingestion were identified, of whom 11 underwent conservative treatments, 6 underwent gastroscopy, and 32 underwent surgery. Among such individuals, eight patients (72.7%) had a successful conservative treatment (number of Buckyballs [NB]: 3.5[IQR: 2.0-4.0]); four patients (66.7%) had Buckyballs successfully removed by gastroscopy (NB: 3.5[IQR: 3.0-5.5]); 16 asymptomatic (50%) patients (NB: 4.0[IQR: 3.0-8.0]) and 16 symptomatic (50%) patients (NB: 8.5 [IQR: 6.25-11.75]) received emergency surgery. Compared to patients who received conservative treatment, the number of ingested Buckyballs was significantly higher in patients who received surgery or gastroscopy (7.0 [IQR: 3.0-10.75] vs 3.5 [IQR: 2.0-4.0], P < .05). The risk of intestinal perforation was significantly higher in symptomatic patients (P < .05) compared to asymptomatic patients.Gastroscopy is recommended when Buckyballs are in the stomach or esophagus. In asymptomatic patients, conservative treatment can be considered for 4 to 6 days. Patients failing conservative treatment, or those who are symptomatic should undergo emergency surgery.
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Affiliation(s)
- David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Adrienne Hughes
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.,Oregon Poison Center, Portland, OR
| | - B Zane Horowitz
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.,Oregon Poison Center, Portland, OR
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Altokhais T. Magnet Ingestion in Children Management Guidelines and Prevention. Front Pediatr 2021; 9:727988. [PMID: 34422734 PMCID: PMC8371313 DOI: 10.3389/fped.2021.727988] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/12/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose: Foreign body ingestion is common in children, and most foreign bodies pass spontaneously without causing serious injuries. Ingestion of multiple high-power magnet pieces is unique and increases the risk of morbidity and mortality. The longer the duration of ingestion, the increased likelihood of complications. Various management options have been reported, and there is no consensus on the ideal management which necessitates the need for a practical algorithm. The incidence of magnet ingestion has been increasing and directly related to the laws and recalls. The aim of this review is to provide an easy and practical pathway for management and to highlight the preventive rules of the legislations and recalls. Methods: PubMed/MEDLINE, the Cochrane Database of Systematic Reviews, and the list of references from all identified complete publications were searched for all publications in English-language for pediatric magnet ingestion. Conclusion: Practical and time-saving management pathways are recommended to minimize the risk of complications. Preventive rules and recalls are important for eliminating the availability of these hazardous magnets. Public awareness about the unique risks posed by these magnets if ingested is important.
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Affiliation(s)
- Tariq Altokhais
- Division of Pediatric Surgery, Department of Surgery, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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