Article Summary
1. Why is this topic important? Pediatric foreign body (FB) ingestions are common, and most ingested FBs pass spontaneously without associated morbidity. Magnetic FB
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.
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
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
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
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. 1. Why is this topic important? Pediatric foreign body (FB) ingestions are common, and most ingested FBs pass spontaneously without associated morbidity. Magnetic FBArticle Summary
They may also present with life-threatening GIT bleeding from an aortoesophageal fistula [18], bowel obstruction, volvulus, intestinal perforation, intestinal fistula, peritonitis, short-bowel syndrome caused by massive bowel resection, life-threatening injuries, and even death caused by ingestion of multiple magnets or co-ingestion of other metallic objects with a magnet [19–31] or may have no symptoms at all even with confirmed ingestion [4]. In one series the intestinal perforation rate was 50% [32]. In our cases, there were multiple complicated enteroenteric fistulae in three cases and multiple perforations of the small intestine in two cases.
Previous data have shown that 52% of patients with magnet ingestion require endoscopic interventions, 28% require surgery, and 34% have perforations and necrosis.12,36 One single-center study found that 56% of patients with multiple magnet ingestion required endoscopy, surgery, or both; another showed that 75% required endoscopic or surgical intervention, with 50% having signs of peritonitis at the time of presentation.23,37 Others have documented that ∼17% of multiple magnet ingestions required partial excision of bowel and almost 5% needed multiple surgeries.12