Multiple Small Magnets: Why Would Not They Pass and Why Did Not We See Them on Endoscopy?

Abstract

An 11-year-old asymptomatic boy was admitted after ingesting 3 magnets. X-rays demonstrated 3 stacked 4 mm metallic objects in the stomach, which quickly moved to the small bowel. Serial imaging demonstrated migration to and stasis in the right hemipelvis (Fig. 1A). After bowel clean-out, ileocolonoscopy was performed. Intraoperative fluoroscopy demonstrated objects in the right pelvis, but not in the bowel lumen (Fig. 1B). The asymptomatic patient was discharged with plans for small bowel enteroscopy. Before the procedure, a pelvic computed tomography (CT) localized the magnets to the appendix (Fig. 2A). An appendectomy was performed, noting the objects attraction to the surgical instruments. Pathology showed an appendix with focal mucosal erosion but without significant inflammation and 3 embedded magnets (Fig. 2B).FIGURE 1: Abdominal X-ray (A) and intraoperative fluoroscopy (B).FIGURE 2: Pelvic computed tomography (A) and gross pathology of the appendix (B).Most ingested materials spontaneously pass within 3.6 days (1). Stasis of small swallowed magnets in the right hemipelvis and an inability to visualize them on endoscopy should raise concern of appendiceal entrapment and consideration of CT. Although rare, a variety of entrapped appendiceal foreign bodies have been reported, including pins and razor blades (2,3). This is the first case of magnets in the appendix, though 1 report suspected magnets causing perforated appendicitis and ileocecal fistula (4). As obstructing foreign bodies may precipitate appendicitis, endoscopic removal or appendectomy is recommended (5).