Gastrointestinal: Pediatric pseudo-single magnet ingestion diagnosed by multidirectional X-ray and computed tomography.

Abstract

Today, many toys are available that contain small powerful magnets, and this has led to an increase in cases of magnet ingestion requiring endoscopic or surgical intervention. Treatment following single magnet ingestion has typically been conservative, necessitating only observation, and with relatively few cases requiring endoscopic removal. Irrespective of the approach, both anteroposterior and lateral radiographs are recommended to confirm the diagnosis and differentiate between single and multimagnet ingestion, with the latter potentially being missed with unidirectional imaging. We report a case of gastrocolic fistula caused by the ingestion of two magnets that appeared as a single magnet on multidirectional radiographs and computed tomography (CT). A 1-year-old girl was referred to Hakodate municipal hospital 3 days after reportedly ingesting a single magnet. Abdominal multidirectional radiography and CT showed only a single oval shadow (Fig. 1a, 1b, and 1c). However, the magnet remained in her stomach by day three of admission. We therefore decided to endoscopic removal under general anesthesia, which revealed that the magnet had become embedded in the posterior wall of the gastric vestibule and could not be removed (Fig. 2a). Therefore, laparoscopic surgery was performed to remove the magnet and repair the gastrocolic fistula (Fig. 2b). After removing the magnet, we realized that the fistula had been caused by the ingestion of two magnets that had appeared as a single magnet on imaging (Fig. 2c). The patient had an uneventful recovery and was discharged on postoperative day 7. Endoscopic removal is advocated following the ingestion of multiple magnets, if present in the stomach or esophagus, because they are associated with a high risk of perforation. Therefore, prompt diagnosis is needed by multidirectional radiography or CT to avoid misdiagnosing a single magnet. As shown in the present case, however, several magnets of the same size and form can be misidentified as one despite using this approach. Given that a review of literature revealed no reports of such misdiagnosis. If conservative management is adopted incorrectly, it can delay appropriate intervention and lead to severe complications. Early endoscopic removal is considered as a choice of treatment in the absence of witnessed ingestion of a single magnet. This case showed gastrocolic fistula caused by the ingestion of two magnets that appeared as a single magnet on multidirectional radiographs and CT.