Abstract
BackgroundAlthough foreign bodies (FBs) typically pass spontaneously and uneventfully through the digestive tract, a subset of such bodies may become trapped, eventually leading to significant injury. In particular, the ingestion of magnetic materials can cause serious morbidity due to proximate attraction through the intestinal wall.Case presentationWe recently treated three pediatric patients who had ingested several magnetic foreign materials. None of these patients exhibited any clinical symptoms or signs suggestive of surgical abdomen. Moreover, it was difficult to determine a definite diagnosis and a treatment plan due to limitations in history taking and radiologic examination. After admission to the hospital, these patients underwent surgery for the following reasons: (1) failure to spontaneously pass ingested foreign materials; (2) sudden-onset abdominal pain and vomiting during hospitalization; and (3) gastric perforation incidentally discovered during gastroduodenoscopy. Subsequently, all patients were discharged without complications; however, their conditions might have been fatal without surgery at an appropriate time.ConclusionsAs the clear identification about the number and characteristics of ingested magnets via radiographic examination or patient history appears to be difficult in pediatric patients, close inpatient observation would be required in any case of undetermined metallic FB ingestion. Patients who are confirmed to have ingested multiple magnets should be regarded as conditional surgical patients, although their clinical conditions are stable.
Highlights
Foreign bodies (FBs) typically pass spontaneously and uneventfully through the digestive tract, a subset of such bodies may become trapped, eventually leading to significant injury
As the clear identification about the number and characteristics of ingested magnets via radiographic examination or patient history appears to be difficult in pediatric patients, close inpatient observation would be required in any case of undetermined metallic foreign bodies (FBs) ingestion
The abdominal cavity was entered via a mid-line incision, and we found that the metallic FB observed via radiography was three attached magnetic FBs; one of these FBs was Discussion In pediatric patients, ingested FBs are typically small objects such as coins, fish bones, marbles, and drugs; a recent meta-analysis indicated that batteries and sharp objects should be removed immediately but that other ingested FBs can be passed spontaneously [4]
Summary
Close inpatient observation should be conducted for any pediatric patients with magnet ingestion, with the exception of patients who are confirmed to have ingested a single magnet by their caregiver or via radiologic examination. Premature discharge from the hospital due to a misdiagnosis or the misconception that a solitary magnet has been ingested may lead to a fatal outcome. Surgical or endoscopic intervention performed before symptoms develop or at the first sign of surgical abdomen could prevent more severe complications. Bowel injuries caused by ingestion of multiple magnets in children: a growing hazard. Prevalence, clinical features and management of pediatric magnetic foreign body ingestions. Pediatric button battery and small magnet coingestion: two cases with different outcomes.
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