Magnets, children and the bowel: A dangerous attraction?

Abstract

Reports of magnet ingestion are increasing rapidly globally. However, multiple magnet ingestion, the subsequent potential complications and the importance of the early identification and proper management remain both under-recognized and underestimated. Published literature on such cases could possibly represent only the tip of an iceberg with press reports, web blogs and government documents highlighting further occurrence of many more such incidents. The increasing number of complications worldwide being reported secondary to magnet ingestion point not only to an acute lack of awareness about this condition among the medical profession but also among parents and carers who will be in most cases the first to pick up on magnet ingestion. There still seems to be no consensus on the management of magnet ingestion with several algorithms being proposed for management. Prevention of this condition remains a much better option than cure. Proper education and improved awareness among parents and carers and frontline medical staff is key in addressing this rapidly emerging problem. The goal of managing such cases of suspected magnet ingestion should be aimed at reducing delays between ingestion time, diagnosis time and intervention time.

Perils in the playpen: Duodenojejunal fistula in a child following ingestion of two toy magnets

“…The symptoms may vary from a completely symptomless child to one with features of obstruction, peritonitis or sepsis. 1 Plain X-ray of the abdomen confirms the presence of a magnet or metallic object. Ultrasound abdomen and CT scans have also been used.…”

“…This parallels the availability of strong permanent magnets in childrens' toys. 5 Magnet ingestion may be seen in normal children as well as those with autism and other behavioral disorders 1,6 . The history of magnet ingestion may be unavailable if the event is unwitnessed or unreliable if reported by a friend or sibling.…”

“…However it may be impossible to determine with certainty if the magnet is single or multiple in some cases. MRI of the abdomen should never be used as it can precipitate a perforation 1 . Modern NIB (alloy of Neodymium, Iron and Boron 7 ) toy magnets are 10 times more powerful than traditional magnets 8 capable of producing attractive forces up to 1300 G. 9 These have been known to erode through the intervening bowel wall resulting in perforation, internal enteric fistulae, internal herniation, adhesions, volvulus, obstruction 2 , mesenteric hemorrhage 4 and death 3 .…”

“…1 Several algorithms designed to direct clinical decisions are available. [2][3][4] The spectrum of complications is possibly only unfolding.…”

Multipl Neodmium magnet ingestion cause of intestinal perforation: A new threat for children

“…Yabancı cisim yutulması durumunda yutulan yabancı cisim mıknatıs ise daha dikkatli davranılması gerekmektedir; çünkü mıknatıs yutulması durumlarında ciddi komplikasyonlar gelişebilmektedir. Tek bir mıknatıs yutulması durumunda konservatif yaklaşılabilmesine rağmen; 2 veya daha fazla mıknatıs yutulması durumunda, mıknatıslar birbirlerini etkileyerek bağırsak duvarlarını aralarında sıkıştırıp basınç nekrozu, obstrüksiyon, volvulus, perforasyon ve fistül benzeri komplikasyonlar yapabileceğinden daha agresif tedavi gerekebilmektedir (1,2,5) . Çoklu mıknatıs yutulmasından şüphelenildiğinde mıknatısların bir araya gelme riski olduğundan multipl radyolojik gö-rüntü ile takip önerilir.…”