Brief Reports
Prevalence, Clinical Features and Management of Pediatric Magnetic Foreign Body Ingestions

https://doi.org/10.1016/j.jemermed.2012.03.025Get rights and content

Abstract

Background

Foreign body (FB) ingestions are frequent in children. Whereas the majority of FBs pass spontaneously through the gastrointestinal tract, ingestion of magnetic FBs pose a particular risk for obstruction due to proximate attraction through the intestinal wall.

Study Objectives

We aimed to identify the prevalence, clinical presentation, and management of magnetic FB ingestions at our tertiary care institution.

Methods

We performed a retrospective chart review of medical records of patients presenting to the pediatric Emergency Department (ED) or admitted to the hospital with FB ingestions from June 2003–July 2009. From those cases, patients with magnetic FB ingestions were identified.

Results

During the study period, 337,839 patients presented to the ED; 38 cases of magnetic FB ingestion were identified (prevalence 0.01%). Abdominal radiography was obtained in all cases. Ingestion of a single magnet occurred in 30 of 38 cases (79%). Of those, 4 patients underwent endoscopic removal due to signs of FB impaction in the esophagus or pylorus; no complications were noted. Ingestion of multiple magnets (range 2–6) occurred in 8 of 38 cases. Four of the 8 patients with multiple magnetic FBs (50%) presented with signs of peritonitis and required operative repair of multiple intestinal perforations. No deaths were identified.

Conclusion

Although ingestion of a single magnetic FB may, in most cases, be managed as a simple FB ingestion, the ingestion of multiple magnetic FB is associated with a high risk of complication and requires aggressive management. We propose an algorithm for management of children with magnetic FB ingestions.

Introduction

Ingestion of a foreign body (FB) is a common presenting complaint in the pediatric Emergency Department (ED). The most frequently identified FBs include coins, small batteries, and jewelry. Most ingested FBs pass spontaneously without associated morbidity. Endoscopic or surgical intervention is considered when a FB causes obstruction due to its large size, or when it is potentially caustic, as in cases of battery ingestions. During the last decade, powerful and small rare-earth magnets have been manufactured and incorporated into toys (1). Two or more magnets separated along their course in the gastrointestinal (GI) tract may attract across bowel walls, causing pressure necrosis with subsequent small bowel obstruction, volvulus, fistula formation, or perforation. In 2006, the Consumer Product Safety Commission report recalled certain toy sets containing small magnets and the Centers for Disease Control and Prevention (CDC) published a detailed report of three cases and a summary of 20 cases of multiple magnetic FB ingestions with associated morbidity and mortality (1). A few case reports of complications after magnetic FB ingestions were published during the last several years 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18. In this study we aimed to review the prevalence, clinical features, and ED management of children presenting to a tertiary ED after ingestion of magnetic FBs.

Section snippets

Materials and Methods

A retrospective chart review was performed to identify all cases of magnetic FB ingestion either discharged from the ED or admitted to the hospital from June 2003 to July 2009. We reviewed medical records of patients evaluated in our ED for FB ingestion with the following International Classification of Diseases, 9th revision codes: 935, 935.0, 935.1, 935.2, 936, 937, and 938. All charts of patients evaluated for FB ingestions were reviewed to abstract the cases where ingestion of magnetic FBs

Results

During the study period, 337,839 patients presented to our ED, and 1826 patients presented with FB ingestions. Thirty-eight individual cases of magnetic FB ingestions were identified. One patient presented to the ED on three separate occasions; he was analyzed as a single case. The overall prevalence of magnetic FB ingestions reported to all ED visits was 0.01%. The prevalence of magnetic FB ingestions reported to the total number of FB ingestions was 1.97%. Table 1 summarizes the

Discussion

This is the first study reporting the prevalence, clinical symptoms, and associated complications of magnetic FB ingestions in children. Our results show that although magnetic FB ingestions are rare in children, ingestion of more than one magnet is associated with a high rate of surgical complications. In our population, we also found an increase in the number of magnetic FB ingestions, endoscopies performed, and occurrences of surgical complications after the CDC warning was published.

The

Conclusion

In summary, although ingestion of a single magnetic FB may, in most cases, be managed as a simple FB ingestion, the ingestion of multiple magnetic FB is associated with a high risk of complications and requires aggressive management. Furthermore, psychiatric comorbidities and developmental delay are not uncommon in children with multiple magnetic FB ingestions.

Article Summary

1. Why is this topic important?

  1. Pediatric foreign body (FB) ingestions are common, and most ingested FBs pass spontaneously without associated morbidity. Magnetic FB

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