Ingestion of Magnetic Toys: Report of Serious Complications Requiring Surgical Intervention and a Proposed Management Algorithm

Abstract

Physicians should have a heightened sense of caution when treating a patient in whom magnetic foreign body ingestion is suspected, because of the potential gastrointestinal complications. An updated management strategy is proposed that both prevents delays in surgical care and avoids unnecessary surgical exploration.

Takes two to tango

“…Ex vivo studies of magnetic beads8 demonstrated that a minimum of 5 beads could form a ring structure and had the potential to trap the bowel wall, as demonstrated in the case reported here (video 1). The same study also found that the distance travelled by the beads prior to their adherence to each other depended on their number, ranging from 3.5 cm (1 : 1 beads) to 4.6 cm (1 : 4 beads).…”

“…Clinicians, however, should have a low threshold for operative intervention if two or more possible magnetic FB are identified within the gastrointestinal tract9 T and a management algorithm has been suggested by Tsai et al 8 for the management of patients with magnetic FB ingestion.…”

Intestinal perforation caused by multiple magnet ingestion

“…Attraction of multiple magnets across the walls of multiple loops of bowel leads to ischaemia and necrosis of trapped bowel wall, which results in serious complications such as bowel obstruction, perforation, fistula formation, volvulus, intraperitoneal haemorrhage and even death. [5,6] Multiple magnet caused multiple intestinal perforations in presented case. Since the magnets are not very strong, the vessels are spared and there was no vascular damage in the presented case.…”

“…However, different approaches were suggested, if the magnets have passed the stomach in asymptomatic patients. Some authors [5,6,9] proposed that close monitoring with serial abdominal X-rays and surgical intervention if abdominal symptoms which are signs of intestinal obstruction or perforation develop, whereas some authors [2,8,10] approached aggressively so that they suggest early surgical intervention when physician cannot remove the magnets via endoscopy. Tsai et al have recommended more detailed algorithm for management of asymptomatic patients.…”

“…According to this algorithm, laparoscopic-assisted exploration and/or endoscopy should be performed in following situations: (i) The magnets are seperated and (ii) magnets are attached to each other and symptoms of abdominal distress develop and/or no distal migration of foreign bodies which can cause entrapping bowel were seen on serial images. [6] However, migration of attached magnets do not always indicate that there will not develop any complications. Butterworth and Feltis observed intestinal perforations in their case although magnets moved distally.…”