Multicenter investigation of pediatric gastrointestinal tract magnets ingestion in China

Abstract

Purpose: To describe the incidence and management of gastrointestinal tract Buckyball magnets ingestions in a multicenter Chinese pediatric patient population, and discuss the preventive measures. Methods: Medical records of 74 pediatric patients from 9 large Chinese hospitals during the past 10 years, who were diagnosed as buckyball magnets ingestion and got invasive treatment, were retrospectively studied. The follow-up was through telephone and outpatient service to estimate the post-surgery condition. Information collection was through online questionnaire. Results: Among the 74 cases, there were 50 boys (68%) and 24 girls (32%). The median age was 36 (interquartile range (IQR) 22-77) months, with a range of 7 months to 11 years, and it showed two peaks, the first between 1 and 3 years, and the second between 6 to 11 years. The annual case number showed a sharp increase over time, and the total case number in the last 2 years (2017 and 2018) showed a greater than 9-fold increase when compared with the first 2 years (2013 and 2014). The majority of ingestions were unintentional, with only 3 patients deliberately swallowing the Buckyball magnets. The median time of ingestion until the onset of emergent symptoms was 2 (IQR 1-5) days, and ranged from 4 h to 40 days. Twenty-one patients had no symptoms, and the remaining cases presented with abdominal pain, vomiting, fever, abdominal distension, excessive crying, melena, and the ceasing of flatus and defecation. Gastroscopy, colonoscopy, laparoscopic surgery and laparotomy surgery were performed in accordance with the algorithm from the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). Procedural and operative findings included gastrointestinal mucosa erosion, ischemia and necrosis, perforation, and abdominal abscess, fistula and intestinal obstruction. The median number of Buckyball magnets ingested was 4 (IQR 2-8), with a range from 1 to 39. During the median follow-up period of 6 (IQR 1-15) months, 3 patients had intestinal obstruction, and one underwent a second operation. The remaining 71 patients courses were uneventful during the follow-up period. None of the 74 patients reported a second swallowing of foreign bodies. Conclusions: The incidence of pediatric gastrointestinal tract magnets ingestion in China is increasing. Management of such patients should follow the NASPGHAN algorithm. Preventive measures to limit children's access to Buckyball magnets should be taken from three levels, namely the national administration, producer, and consumer.

Magnet Beads Impacted in the Appendix of a Child: A Case Report and Review of the Literature

“…Other commonly ingested foreign bodies include fish bones, pins, button batteries, magnets, household items, food boluses, and many others. They can get stuck anywhere in the gastrointestinal tract, starting from the proximal esophagus to the colon, manifesting in the form of various signs, symptoms, and complications [ 3 , 6 ].…”

“…The ingestion of magnets is a serious health hazard for children that can lead to grave consequences if not managed promptly. Multiple magnets across the gastrointestinal tract can attract each other, thus attracting different segments of the bowel together [ 3 ]. This can eventually lead to bowel ischemia, enteroenteric fistulas, bowel perforation, and peritonitis [ 3 , 6 ].…”

“…From the variety of foreign bodies that could be ingested by children, magnets are considered to be specifically dangerous if >1 magnet is ingested due to their ability to attract and pull each other across bowel layers, leading to pressure necrosis, perforation that could lead to sepsis, or even death [1,2]. Management of such cases varies according to multiple factors, such as clinical presentation, the number of ingested magnets, location of the magnets, and ensuing complications [3]. Follow-up with serial imaging can be carried out as a form of initial management in stable patients.…”

“…Follow-up with serial imaging can be carried out as a form of initial management in stable patients. However, in unstable patients, clinical deterioration, and failure of magnets to progress through the gastrointestinal tract with failure of retrieval endoscopically, surgical intervention is indicated [2,3].…”

Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China.

“…Accordingly, in some areas of the USA, the incidence of multiple magnet ingestion has decreased 6 . In China, although there are warning labels on the toy packages, a recent multicenter investigation shown that the incidence of multiple magnet ingestions is increasing 7 . As our data show, the number of patients in 2019 was approximately four times higher than that in 2015.…”