Multiple Magnet Ingestion Research Articles

Laparoscopic Retrieval of “Stubborn” Foreign Bodies in the Foregut

Foreign bodies (FBs) are commonly seen in pediatric and gastroenterologist practice. Most of them will pass without intervention; those that do not will need surgery. Laparoscopy has been used to achieve this to good effect. We present a child with ingestion of multiple magnets. The patient was a 2-year-old child with history of ingestion of magnets. Laparoscopy was planned as endoscopic removal had failed. There were 3 magnets in the stomach and 1 in the jejunum and they were attached together, as if in a "gastrojejunostomy." Laparoscopic removal was performed successfully for the child. He had an uneventful postoperative recovery and was discharged on the third postoperative day. Coins are the most commonly ingested FBs. Multiple magnet ingestion poses a unique problem, as they are likely to stick together and cause pressure necrosis with fistula formation. Surgical intervention is necessary to prevent this potentially deadly complication. Laparoscopy has been found to be very useful in the removal of intraluminal FBs, especially when conservative measures fail. Prevention should be the main objective and parental involvement is crucial.

Magnetic attraction leading to a small bowel obstruction in a child

Foreign body ingestion in small children is common yet only 1% of cases require operative management of associated complications (Arana et al. in Eur J Pediatr 160:468-472, 2001). A 6-year-old boy was referred to our institution with a 12 h history of abdominal pain. This pain was diffuse and crampy in nature and associated with multiple episodes of non-bilious, non-bloody emesis. On evaluation he was stable and his abdomen demonstrated slight distention and tenderness without peritoneal signs. Plain abdominal radiographs demonstrated some distended loops of small bowel and a radio-opaque foreign object within the mid-abdomen. A small bowel obstruction secondary to foreign body ingestion was diagnosed and an emergent laparotomy performed. Upon exploration, a transition zone was noted near the ileocecal valve. Further exploration revealed the obstruction to be caused secondary to the apposition of two small (8 mm) magnets, one in the proximal ileum and the other near the ileocecal valve, resulting in an internal hernia. The magnets were easily separated relieving the obstruction and both were removed via two small bowel enterotomies. After being presented with the magnets, his parents suspected that they came from the clothes of a Polly Pocket (Mattel, Inc., El Segundo, CA) doll. The patient had an uneventful post-operative course and was discharged to home on the second post-operative day. This case demonstrates the complications that may occur with multiple magnet ingestion. It highlights the need for close observation and early surgical intervention in children with a suspected history of foreign body ingestion, a clinical picture of gastrointestinal distress, and radiographic evidence of a radio-opaque foreign object.

Ingestion of magnetic foreign bodies causing multiple bowel perforations

We report a 3-year-old boy who presented to the emergency room with the suspicion of having swallowed an unknown number of industrial metallic objects, subsequently shown to be magnets. During the hospital course, the boy developed multiple bowel perforations caused by the swallowed magnets that were attracted across the bowel walls. The patient management was delayed as the radiographic appearance of the foreign object did not immediately reveal that multiple magnets were stuck to one another. By this report we aim to alert the radiological and pediatric community to the possible presentation of multiple magnet ingestion. If multiple magnets or a combination of magnets and metallic objects are suspected, immediate radiographic evaluation is warranted for confirmation, and urgent surgical exploration may be necessary to prevent bowel perforation and/or intraabdominal abscess formation.

Multiple Magnetic Foreign Body Ingestion: A Surgical Problem

Multiple Magnetic Foreign Body Ingestion: A Surgical Problem

Ingested magnets and gastrointestinal complications

Multiple magnet ingestion is an unexpected health hazard in children that can lead to significant gastrointestinal morbidity. The magnets are attracted to each other across the bowel wall and this may lead to pressure necrosis, resulting in perforation, fistula formation, and/or intestinal obstruction. We report herein a case of small bowel obstruction following ingestion of two magnets. The public and clinicians should be aware of the health hazard of such devices.

How Strong Construction Toy Magnets Are! A Gastro‐Gastro‐Duodenal Fistula Formation

Children like to play with many kinds of magnetic construction toys, and their size and shape make them easy to swallow. They can cause serious complications such as intestinal obstruction, perforation, and fistula formation when multiple magnets are ingested (1–3). Ingestion accidents can occur frequently in young children, especially those with developmental disabilities (1,3). We introduce an extremely unusual case involving the ingestion of multiple construction toy magnets that formed a gastro-gastro-duodenal fistula formation without bowel perforation. A 12-y-old boy with autism presented to the emergency department after vomiting for 4 d. On clinical examination he was afebrile and had no abdominal distension or peritoneal irritation. An abdominal x-ray demonstrated that the multiple radiopaque bar objects arranged in multiple tandem structures were found in the stomach (Fig. 1A). The exact time of the ingestion could not be ascertained because the ingestion was not witnessed and the patient was nonverbal. On showing the x-ray to his parents, they recognized the foreign bodies as parts of a magnetic educational construction toy, and they recalled that 22 rods had disappeared from the toy box. An esophagogastroduodenoscopy (EGD) was performed under general anesthesia. After repeated EGD with a polypectomy snare, 17 of 22 rods were removed from the stomach. Then it was noticed that 1 rod was deeply embedded in the fundic wall of the gastric angle (Fig. 1B), and its distal end was found in the antral side across the gastric angle. In the antrum this embedded rod was being attracted by another magnetic rod, which had passed through the prepyloric antral wall into the duodenum (Fig. 1C). Hence, these 2 connected magnets had caused the formation of a gastro-gastro-duodenal penetration. This tandem complex of 2 magnets was connected with another tandem complex of 3 pieces, forming a “T” shape, in the duodenal bulb (Fig. 1C). A surgery consult was obtained for suspected bowel perforation despite the lack of free air on the x-ray. An operation or EGD removal was scheduled after a further evaluation of the risk of perforation or bleeding. However, an abdominal x-ray taken the next day revealed that the remaining 5 rods were located in the descending colon (Fig. 1D); there was no sign of peritoneal irritation on physical examination and no sign of perforation by radiographic and ultrasonographic evaluations. The patient was treated with a proton pump inhibitor for 14 d, and a follow-up EGD showed that the fistulas in the stomach and duodenum had completely healed.FIG. 1: A, An assemblage of multiple radiopaque bar objects in the stomach. B, A magnetic rod is deeply embedded in the fundic wall, and (C) this protrudes across the gastric angle and attracts another rod in the antrum. This antral rod also penetrates the prepyloric antral wall into the duodenum. D, Five magnetic rods in the descending colon. F indicates fundic wall; A, antral wall; P, pyloric ring.In the present case, the pressure exerted on the respective walls of the bowel because of magnetic attraction and the pressure of gastroduodenal peristalsis probably led to local pressure necrosis and perforation with attracted rods, which dramatically demonstrates the strength of construction toy magnets. After 17 pieces had been endoscopically removed, the remaining magnets appeared to lose the ability to resist gastroduodenal peristalsis, and were probably dislodged from their embedded positions in gastric and duodenal walls. Fortunately, the lesions that had developed in the stomach and duodenum healed without perforation or bleeding. We suggest that warning labels concerning the unique dangers of ingesting magnetic toys be implemented on all packaging.

Intestinal Volvulus and Perforation Caused by Multiple Magnet Ingestion: Report of a Case

Ingested magnets can cause intestinal fistulas, perforation, and obstruction. There have been reports of magnet ingestion causing intestinal volvulus, but multiple magnet ingestion causing perforation and intestinal volvulus in a child is very unusual. We report the case of a 4-year-old girl, who ingested four magnets she acquired as toys, which caused intestinal volvulus and perforation as a result of pressure necrosis, several days after ingestion. At surgery we repaired two perforations, but additional bowel resection was not required. The patient was discharged on postoperative day 10. If multiple magnet ingestion is suspected in a child, the child must be monitored carefully. If there are signs of obstruction, emergency surgery is mandatory.

Gastrojejunal Fistula with Jejunal Rotation Caused by Two Ingested Magnets in a Child: A Case Report

Among the common foreign bodies that are ingested by children, ingesting multiple magnets is known to be hazardous due to the gastrointestinal complications caused by the magnets attracting each other across the bowel walls. We present here a case of gastrojejunal fistula and jejunal rotation that was caused by two ingested magnets in a 5-year-old girl, and we also present the findings of simple abdomen radiography, a small bowel series and computed tomography. The unchanged position of the radiopaque metallic foreign bodies on the serial abdominal radiographs suggests the inadvertent ingestion of multiple magnets.

Ingestion of multiple magnets: hazardous foreign bodies for children

We report a case of perforation, fistula formation, and small bowel obstruction in a 2-year-old child who had ingested 32 small magnets. Multiple magnets will attract one another through the bowel wall and lead to pressure necrosis with complications. We recommend early surgical intervention before the onset of gastrointestinal complications if ingested multiple magnets have not moved on the follow-up radiograph. Both clinicians and the lay population need to be aware that multiple magnets can be hazardous foreign bodies for children.

An unusual source of abdominal pain after adjustable gastric banding

Foreign body ingestion is relatively common in children, but much less so in adults. Ingested items such as coins, bones, dentures, and toothpicks may cause dysphagia, abdominal pain, and other gastrointestinal symptoms [1]. Of the foreign objects that reach the stomach, 97% will travel through the alimentary tract uneventfully, with only 1% requiring surgical intervention [2]. Multiple magnet ingestion is a rare and dangerous occurrence. Although a single magnet may pass through the gastrointestinal tract spontaneously, multiple magnets ingested in close succession may attract one another through separate loops of bowel.

An intestinal volvulus caused by multiple magnet ingestion: an unexpected risk in children

It has been reported that ingested magnets can cause intestinal fistula formation or perforation, leading to intestinal obstruction. However, there are no previous case reports that magnet ingestion additionally caused an intestinal volvulus. We report herein the case of a 1-year-old boy in whom the ingested magnets caused a volvulus of part of the small intestine leading to the resection of the necrotic portion. We think that if more than one magnet is found as a foreign body in the intestine, they should be removed immediately by laparotomy. Clinicians who care for children should be aware of this unexpected risk.

Pediatric foreign bodies and their management

Ingestion of foreign bodies is a common pediatric problem, with more than 100,000 cases occurring each year. The vast majority of pediatric ingestions are accidental; increasing incidence of intentional ingestions starts in the adolescent age group. In the United States, the most common pediatric foreign bodies ingested are coins, followed by a variety of other objects, including toys, toy parts, sharp objects, batteries, bones, and food. In adolescents and adults, meat or food impactions are the most common accidental foreign body ingestion. Esophageal pathology underlies most cases of food impaction. Management of foreign body ingestions varies based on the object ingested, its location, and the patient's age and size. Esophageal foreign bodies as a group require early intervention because of their potential to cause respiratory symptoms and complications, esophageal erosions, or even an aortoesophageal fistula. Ingested batteries that lodge in the esophagus require urgent endoscopic removal even in the asymptomatic patient due to the high risk of complications. Sharp foreign bodies increase the foreign body complication rate from less than 1% to 15% to 35%, except for straight pins, which usually follow a relatively benign course unless multiple pins are ingested. Magnets are increasingly ingested, due to their ubiquitous nature and the perception that they do not pose a risk. Ingestion of multiple magnets creates a significant risk of obstruction, perforation, and fistula development. Methods to deal with foreign bodies include the suture technique, the double snare technique, and the combined forceps/snare technique for long, large, and sharp foreign bodies, along with newer equipment, such as retrieval nets and a variety of specialized forceps.

Surgical Intervention for the Ingestion of Multiple Magnets by Children

Haraguchi, Masashi MD*; Matsuo, Shigetoshi MD*; Tokail, Hirotaka MD*; Azuma, Takashi MD*; Yamaguchi, Satoshi MD*; Dateki, Sumito MD†; Fukahori, Kazunari MD†; Kanematsu, Takashi MD‡ Author Information