Fatal Attraction: Awareness of the Management of Ingested Multiple Magnets or Single Magnet and a Metallic Object

Abstract

Purpose: Most ingested gastric foreign bodies will pass spontaneously from the stomach. However, if these objects are more than 5 cm long, corrosive in nature, sharp, or magnetic they should be removed immediately. The purpose of this case report is to alert clinical providers to the detrimental effects on the gastrointestinal tract when more than one ingested magnet or a single magnet and magnetic object is not removed urgently. If not removed, pressure necrosis resulting from attraction between the magnetic objects across two bowel loops leads to perforation, hemorrhage, volvulus or even death. We describe 3 asymptomatic pediatric patients with known ingestion of multiple magnets. All had successful endoscopic retrieval avoiding possible complications. Case 1: 3 year old swallowed 16 plastic coated cylindrical magnets (resembling mint candy), part of a magnetic building set. Radiograph revealed 14 magnets arranged in a circle in the stomach and 2 in the small bowel. The gastric magnets were removed endoscopically with a snare. Other 2 magnets passed uneventfully. Case 2: 3 year old swallowed 2 magnetic toy pieces. X-ray confirmed gastric and proximal duodenal location. Successful retrieval of both was accomplished with a Roth Net. Case 3: 9 year old swallowed 2 dumbbell toy magnets. X-ray revealed gastric location. At endoscopy, the magnets were separated from retained food as they attracted to the biopsy forceps, and then removed with a Roth Net. Conclusions: Public and physicians must be made aware of the urgency of managing patients who have ingested multiple magnets or a single magnet and magnetic object to prevent significant morbidity and mortality. In unknown ingestions, when the radiologist determines that more than one metallic object is present radiographically, the clinician should be contacted to verify if one of them is magnetic. If there is a suspicion of magnets, which are accessible with an endoscope, they should be removed urgently; even if asymptomatic. If inaccessible endoscopically, the patient must be observed vigilantly for possible complications.