Multiple Small Magnets

Abstract

An 11-year-old asymptomatic boy was admitted after ingesting 3 magnets. X-rays demonstrated 3 stacked 4 mm metallic objects in the stomach, which quickly moved to the small bowel. Serial imaging demonstrated migration to and stasis in the right hemipelvis (Fig. 1A). After bowel clean-out, ileocolonoscopy was performed. Intraoperative fluoroscopy demonstrated objects in the right pelvis, but not in the bowel lumen (Fig. 1B). The asymptomatic patient was discharged with plans for small bowel enteroscopy. Before the procedure, a pelvic computed tomography (CT) localized the magnets to the appendix (Fig. 2A). An appendectomy was performed, noting the objects attraction to the surgical instruments. Pathology showed an appendix with focal mucosal erosion but without significant inflammation and 3 embedded magnets (Fig. 2B).Most ingested materials spontaneously pass within 3.6 days (1). Stasis of small swallowed magnets in the right hemipelvis and an inability to visualize them on endoscopy should raise concern of appendiceal entrapment and consideration of CT. Although rare, a variety of entrapped appendiceal foreign bodies have been reported, including pins and razor blades (2,3). This is the first case of magnets in the appendix, though 1 report suspected magnets causing perforated appendicitis and ileocecal fistula (4). As obstructing foreign bodies may precipitate appendicitis, endoscopic removal or appendectomy is recommended (5).

Reply to Letter to the Editor

“…Given the risks, inability to localize all magnets, and concern for possible perforation, the remaining magnets were surgically removed, for a total of 16 magnets. As in our case, Krasaelap et al (3) demonstrates the need for concomitant endoscopic and surgical exploration in cases of multiple magnet ingestion because of risk of fistulization, given the potential to embed in the mucosal wall, preventing visualization of ingested objects solely via endoscopy.…”

The Refinement of Radiographic Protocols in Assessment of Pediatric Foreign Body Ingestions

“…Radiography remains the standard of care, though recently point-of-care ultrasound and hand-held metal detectors have been studied as alternative tools in assessing the presence and location of FBIs (3,4). Other reports have demonstrated the utility of CT scan in more precise identification of magnets that have been difficult to locate on endoscopy and with conventional radiology (5). Regardless of methodology, anatomic location remains the most crucial aspect in management of these ingestions.…”