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, 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 showed a greater than 9-fold increase when compared with the first 2 years. 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. 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. 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). 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 were uneventful during the follow-up period. 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. Keywords: Pediatric, Gastrointestinal tract, Magnetic foreign body, Buckyball

Etiology and surgical management of pediatric acute colon perforation beyond the neonatal stage

“…We noted that all incidences of ingestion of foreign objects occurred after 2018. This is similar to a 2020 study that found recent increase in pediatric gastrointestinal tract magnets ingestion in China [8]. Second, colorectal adenocarcinoma led to 2 colon perforations in this study.…”

“…First, despite literature reporting peak incidence of colon perforation due to foreign object ingestion being between 6 months to 3 years [7], of the 5 incidences, only 1 patient was younger than 2 years old. While most objects can be passed out of the alimentary tract without incident, 1-5.6 % result in colon perforation [7,8]. We noted that all incidences of ingestion of foreign objects occurred after 2018.…”

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

“…Therefore, the USA government has forced toy companies to recall certain magnetic toys. 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 .…”