51
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Li XL, Zhang QM, Lu SY, Liu TT, Yao ZM, Zhang WP, Chen YJ, Chen L, Xie FN. Clinical report and analysis of 24 cases of multiple magnetic beads foreign body in gastrointestinal tract of children. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:819-824. [PMID: 33361046 DOI: 10.5152/tjg.2020.19600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS This study aimed to analyze the data of 24 cases of multiple perforation or obstruction of the digestive tract caused by accidental ingestion of magnetic beads, to improve the understanding of its harmfulness to children and explore the best treatment. MATERIALS AND METHODS In total, 24 cases were collected and retrospectively analyzed. These patients were divided into two groups: perforation group and non-perforation group. The medical history, number of magnetic beads, white blood cell (WBC) count, and C-reactive protein (CRP) were analyzed. RESULTS There was no significant difference in age, gender, medical history, number of magnetic beads, and WBC count between the perforation group and non-perforation group, but there was a significant difference in CRP. After the diagnosis, 70% of the cases underwent laparotomy and perforation repair. All cases recovered smoothly after the operation, and no complications occurred during the follow-up. CONCLUSION This study offers diagnosis and treatment methods for the perforation or obstruction of the digestive tract caused by accidental ingestion of magnetic beads and raises the awareness regarding the harmfulness of the presence of foreign bodies in the digestive tract.
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Affiliation(s)
- Xian-Ling Li
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qin-Ming Zhang
- Department of Surgery, Beijing United Family Hospital, Beijing, China
| | - Shou-Yan Lu
- Department of Surgery, Beijing Aiyuhua Women's and Children's Hospital, Beijing, China
| | - Ting-Ting Liu
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zi-Ming Yao
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wei-Ping Zhang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ya-Jun Chen
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Long Chen
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Fang-Nan Xie
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Cai DT, Shu Q, Zhang SH, Liu J, Gao ZG. Surgical treatment of multiple magnet ingestion in children: A single-center study. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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53
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Cai DT, Shu Q, Zhang SH, Liu J, Gao ZG. Surgical treatment of multiple magnet ingestion in children: A single-center study. World J Clin Cases 2020; 8:5988-5998. [PMID: 33344597 PMCID: PMC7723714 DOI: 10.12998/wjcc.v8.i23.5988] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Since 2017, the number of magnet ingestion cases has increased year over year in our hospital. Almost all of the ingested magnetic foreign bodies were magnetic beads, and most of the patients experienced intestinal perforations, causing substantial damage.
AIM To summarize our experience with surgical treatment of multiple magnet ingestion in children.
METHODS The data for general surgeries were collected from January 2010 to April 2020, and the clinical characteristics, treatment methods, and outcomes were summarized and analyzed. Several typical cases were selected and discussed.
RESULTS Fifty-six cases of ingested magnetic foreign bodies were collected, of which 47 were magnetic beads. The average patient age was 4.7 ± 3.0 years old. The number of ingested magnetic foreign bodies ranged from 2 to 73. There were 26 cases with symptoms at the time of admission, including two cases of shock. Thirteen patients were discharged successfully following conservative treatment and 43 were treated by surgery. Laparotomy was the main method of operation. Laparoscopy was used in four cases, of which three were converted to open surgery, and one was treated successfully using surgery through the navel. Postoperative complications occurred in seven cases, incision infections were observed in six, and adhesive ileus was observed in one.
CONCLUSION Clinicians need to summarize their experiences with treating magnetic foreign body ingestions in detail and carry out clinical research to reduce the damage to children.
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Affiliation(s)
- Duo-Te Cai
- Department of General Surgery, the Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310051, Zhejiang Province, China
- Department of General Surgery, National Clinical Research Center for Child Health, Hangzhou 310051, Zhejiang Province, China
| | - Qiang Shu
- Department of Pediatric Surgery, the Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang Province, China
- Department of Pediatric Surgery, National Clinical Research Center for Child Health, Hangzhou 310058, Zhejiang Province, China
| | - Shu-Hao Zhang
- Department of General Surgery, the Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310051, Zhejiang Province, China
| | - Jia Liu
- Department of Ear, Nose, and Throat Surgery, the Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310051, Zhejiang Province, China
| | - Zhi-Gang Gao
- Department of General Surgery, the Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310051, Zhejiang Province, China
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54
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Magnet Ingestions in Children Presenting to Emergency Departments in the United States 2009-2019: A Problem in Flux. J Pediatr Gastroenterol Nutr 2020; 71:699-703. [PMID: 32969961 DOI: 10.1097/mpg.0000000000002955] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Small rare-earth magnet (SREM) ingestions are a dangerous, potentially fatal health hazard in children. The U.S. Consumer Safety Commission removed these products from the market in 2012 until a federal court decision vacated this action in 2016. The present study aims to investigate whether the reintroduction of SREMs is associated with an increase in the national frequency of magnet ingestions in children. PATIENTS AND METHODS Data from the National Electronic Injury Surveillance System (NEISS) were used to evaluate suspected magnet ingestion (SMI) trends within patients (0-17 years) from 2009 to 2019. SMI cases were stratified (total, small/round, and multiple magnet ingestions) and trend analyses were performed for 2 periods: 2013-2016 (off-market) and 2017-2019 (on-market). National SMI estimates calculated using the NEISS-supplied weights and variance variables. RESULTS An estimated 23,756 children (59% males, 42% < 5 years old) presented with a SMI from 2009 to 2019 with an average annual case increase of 6.1% (P = 0.01). There was a significant increase in both small/round SMI encounters and multiple magnet ingestion encounters from 2009 to 2019 (P < 0.001 and P < 0.01, respectively). From 2017 to 2019, there was a greater proportion of small/round type SMIs to total SMIs estimated n = 541 (confidence interval [CI], 261-822) and a greater proportion of multiple magnet ingestions to total SMIs estimated n = 797 (CI, 442-1152) (both, P < 0.01). After 2017, there was a 5-fold increase in the escalation of care for multiple magnet ingestions (estimated n = 1094; CI 505-1686). CONCLUSIONS The significant increase in magnet ingestions by children from 2017 to 2019 indicates that regulatory actions are urgently needed to protect children and reverse these trends.
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Oliva S, Romano C, De Angelis P, Isoldi S, Mantegazza C, Felici E, Dabizzi E, Fava G, Renzo S, Strisciuglio C, Quitadamo P, Saccomani MD, Bramuzzo M, Orizio P, Nardo GD, Bortoluzzi F, Pellegrino M, Illiceto MT, Torroni F, Cisarò F, Zullo A, Macchini F, Gaiani F, Raffaele A, Bizzarri B, Arrigo S, De' Angelis GL, Martinelli M, Norsa L. Foreign body and caustic ingestions in children: A clinical practice guideline. Dig Liver Dis 2020; 52:1266-1281. [PMID: 32782094 DOI: 10.1016/j.dld.2020.07.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
Foreign body and caustic ingestions in children are usually the most common clinical challenges for emergency physicians, general pediatricians and pediatric gastroenterologists. Management of these conditions often requires different levels of expertise and competence. Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect timing and indications. The imprecise clinical history frequently leaves clinicians uncertain about timing and nature of the ingestion. Few clinical guidelines regarding management of these ingestions in children have been published, none of which from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working Group to produce the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body and caustic ingestions. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed the project since many adult endoscopists usually manage children with these conditions. Differently from the other published guidelines, the proposed one focuses on the role of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists) in the diagnostic process of children with foreign body and caustic ingestions.
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Affiliation(s)
- Salvatore Oliva
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy.
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology and Pediatrics, University of Messina, Italy
| | - Paola De Angelis
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Isoldi
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Cecilia Mantegazza
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics and Pediatric Surgery, University of Milan, Buzzi Children's hospital, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Emanuele Dabizzi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | | | - Matteo Bramuzzo
- Pediatric Gastroenterology, Digestive Endoscopy and Clinical Nutrition Unit, Department of Pediatric, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital
| | | | - Maristella Pellegrino
- Pediatric Surgery Unit, Maternal and Child Department, ASST GOM of Niguarda, Milan, Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics, "Santo Spirito" Hospital of Pescara, Italy
| | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child health, IRCCS Policlinico San Matteo Pavia and Department of Clinical-Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy
| | - Gian Luigi De' Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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56
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Han Y, Youn JK, Oh C, Lee S, Seo JM, Kim HY. Ingestion of multiple magnets in children. J Pediatr Surg 2020; 55:2201-2205. [PMID: 31937446 DOI: 10.1016/j.jpedsurg.2019.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The ingestion of multiple magnets is harmful in children because it can cause intestinal obstruction and/or perforation. We present an approach for the management of children visiting the emergency department with multiple magnet ingestion. METHODS We retrospectively investigated 9 children who presented to 2 centers in Korea between January 2004 and August 2018 with a history of multiple magnet ingestion. Demographics, major symptoms, management, and outcomes were analyzed. RESULTS Of the 9 children investigated, median age was 34 months with vomiting and abdominal pain as the most common initial symptoms. Six (67%) underwent surgical removal of the magnets after observing for mean 2.2 days. Reasons for surgical managements were no magnet migration on serial radiographs in 3, suspected obstruction or microperforation in 2 and failed endoscopic removal in 1. Three patients (33%) were asymptomatic and were treated with meticulous observation using serial plain radiographs for average 3.3 days. All patients discharged without adverse outcomes and complications. CONCLUSIONS Surgical removal is warranted in patients with symptoms suspicious of intestinal obstruction and/or perforation or without magnet migration. Asymptomatic children can be observed over at least 2-3 days with serial simple radiographs while awaiting magnet migration. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yireh Han
- Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Chaeyoun Oh
- Department of Surgery, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Magnet ingestion by children: A retrospective study in a medical center in Taiwan. Pediatr Neonatol 2020; 61:542-547. [PMID: 32682694 DOI: 10.1016/j.pedneo.2020.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 04/22/2020] [Accepted: 06/09/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The ingestion of multiple magnets may lead to severe complications including bowel obstruction, perforation, fistula, peritonitis, short bowel syndrome, life-threatening injuries, and even death. The annual case number of high-powered neodymium magnets ingestion has been increasing in the western world and the dearth of available data demonstrates that this issue has been neglected in Taiwan. METHODS We searched the electronic medical records of our institution for patients younger than 18 years old who were diagnosed with, who had ever visited our emergency department, or been hospitalized for magnetic foreign body ingestion between January 2009 and March 2018. Demographic data including the number, shape, and size of magnets ingested, the clinical presentation, type of intervention, and complications were reviewed. RESULTS Thirteen patients who met the enrollment criteria were analyzed. One patient was documented between 2009 and 2013, and twelve were documented between January 2014 and March 2018. Five of the cases documented between 2014 and 2018 had ingested Buckyballs. The median age of the patients was 5 years. All of the patients with clinical symptoms had ingested more than one magnet and required endoscopic or surgical intervention. Bowel perforation or deep ulcer with impending perforation was found in three patients during surgery. CONCLUSION The number of children who visited our emergency department or were hospitalized due to the ingestion of magnets has increased recently. The presence of high power of neodymium magnets in many products increases the risk of ingesting multiple magnets resulting in serious complications. Therefore, stricter policies are needed to prevent children from obtaining products that contain magnets.
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Endoscopic Management of the Ascending Colon Perforation Secondary to a Rare-Earth Magnets Ingestion in a Pediatric Patient. ACG Case Rep J 2020; 7:e00436. [PMID: 32821766 PMCID: PMC7423915 DOI: 10.14309/crj.0000000000000436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/21/2020] [Indexed: 12/11/2022] Open
Abstract
Rare magnets (neodymium magnets) are high-powered magnets known to cause intestinal perforation if the intestinal mucosa is trapped in between 2 or several magnets. A bowel perforation in pediatric patients secondary to magnets is usually managed with a surgical intervention that might require enterectomy. We report a case of an 11-year-old boy who presented with abdominal pain and a finding on abdominal x-ray of radiopaque foreign bodies located in the ascending colon. He underwent colonoscopy with a finding of embedded magnets with a colonic perforation. The colonoscopy revealed embedded magnets in the colonic mucosa that were colonoscopically removed, and then, the perforated site was successfully managed with endoclipping of the perforation site in the ascending colon.
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59
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Abstract
Foreign body ingestion is frequently the cause of emergency visits in the pediatric population, and these cases are challenging to diagnose and manage. In particular, the ingestion of magnets is dangerous and can lead to serious complications and even death. Urgent endoscopic intervention or surgical exploration remains the best approach for removing multiple ingested magnets and preventing further injury to the gastrointestinal (GI) tract. We report a nine-year-old child with an adjustment disorder who developed a gastrocolic fistula following the deliberate ingestion of multiple magnets. The magnets were successfully retrieved after an emergency laparotomy, and the fistula was subsequently repaired.
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Affiliation(s)
- Alaa Ali
- Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
| | - Saeed Alhindi
- Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
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60
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Multiple Magnetic Beads Cause Intestinal Obstruction. J Pediatr Gastroenterol Nutr 2020; 71:e53. [PMID: 32349037 DOI: 10.1097/mpg.0000000000002755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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61
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Strickland M, Diamond IR, Rosenfield D. Case Discussions and Radiographic Illustration of Magnet-Related Injuries in Children. J Emerg Med 2020; 58:902-909. [PMID: 32317194 DOI: 10.1016/j.jemermed.2020.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/17/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Injuries from multiple magnet ingestions in the pediatric population have been increasing in both incidence and morbidity. This trend will likely continue after a 2017 court ruling that overturned a ban on the sale of magnet sets marketed as "adult desk toys." Depending on the arrangement of the ingested magnets in the gastrointestinal tract, the consequences can range from benign to life threatening. OBJECTIVE This review of cases aims to help clinicians recognize this pathology and help them appreciate the unique management of this type of foreign body ingestion. DISCUSSION Several cases are presented that individually illustrate an arm of the most comprehensive management algorithm, proposed by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. The management is largely driven by the clinical appearance of the child as well as information obtained through abdominal radiographs. Imaging variables that factor into management include the location of the magnets, the number of magnets, and the progression of magnets on serial radiographs. CONCLUSION This article uses cases and illustrative medical imaging to describe the most common scenarios and their management. This is especially relevant considering recent U.S. court rulings that overturned the U.S. Consumer Product Safety Commission's ban on the sale of toys containing multiple miniature magnets.
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Affiliation(s)
- Matt Strickland
- Department of Surgery, University of Southern California, Los Angeles, California; Los Angeles County + University of Southern California Medical Center, Los Angeles, California
| | - Ivan R Diamond
- Department of Diagnostic Imaging, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Rosenfield
- Department of Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto Department of Pediatrics, Toronto, Ontario, Canada
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Wang K, Zhang D, Li X, Wang Z, Hou G, Jia X, Niu H, Qi S, Deng Q, Jiang B, Bian H, Yang H, Chen Y. Multicenter investigation of pediatric gastrointestinal tract magnets ingestion in China. BMC Pediatr 2020; 20:95. [PMID: 32111182 PMCID: PMC7049183 DOI: 10.1186/s12887-020-1990-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/20/2020] [Indexed: 12/13/2022] Open
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.
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Affiliation(s)
- Kai Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Dan Zhang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Xianling Li
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Zengmeng Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Guangjun Hou
- Department of General Surgery, Zhengzhou Children's Hospital, Zhengzhou, 450053, Henan, China
| | - Xinjian Jia
- Department of General Surgery, Xi'an Children's Hospital, Xi'an, 710043, Shaanxi, China
| | - Huizhong Niu
- Department of General Surgery, Children's Hospital of Hebei Province, Shijiazhuang, 050030, Hebei, China
| | - Shiqin Qi
- Department of General Surgery, Anhui Provincial Children's Hospital, Hefei, 340111, Anhui, China
| | - Qingqiang Deng
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang, 330006, Jiangxi, China
| | - Bin Jiang
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Hongqiang Bian
- Department of General Surgery, Wuhan Children's Hospital, Wuhan, 430015, Hubei, China
| | - Heying Yang
- Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China.
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Schreiber-Dietrich D, Hocke M, Braden B, Carrara S, Gottschalk U, Dietrich CF. Pediatric Endoscopy, Update 2020. APPLIED SCIENCES 2019; 9:5036. [DOI: 10.3390/app9235036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Optimal management of pediatric endoscopy requires a multidisciplinary approach. In most hospitals, endoscopy in pediatric patients is performed by conventional gastroenterologists and only a few centers have specialized pediatric gastroenterologists. This is due to the fact that the number of pediatric gastroenterologists is limited and not all of them are experienced in endoscopic techniques. However, there are also some pediatric centers offering a high-quality and high-volume endoscopy service provided by very experienced pediatric gastroenterologists. Up to now, the literature on pediatric endoscopy is rather sparse. In this article, we describe current knowledge and practice of endoscopic procedures in pediatric patients, which should be relevant for both the adult and pediatric gastroenterologists.
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Affiliation(s)
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Bergstr. 3, D-98617 Meiningen, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK
| | - Silvia Carrara
- Humanitas Clinical and Research Center-IRCCS-Digestive Endoscopy Unit, Division of Gastroenterology, Via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Uwe Gottschalk
- Klinik für Innere Medizin I, Dietrich Bonhoeffer Klinikum, 17036 Neubrandenburg, Germany
| | - Christoph F Dietrich
- Med Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Uhlandstr. 7, D-97980 Bad Mergentheim, Germany
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Schänzlihalde 11, 3013 Bern, Switzerland
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Arshad M, Jeelani SM, Salim A, Hussain BD. Multiple Magnet Ingestion leading to Bowel Perforation: A Relatively Sinister Foreign Body. Cureus 2019; 11:e5866. [PMID: 31763089 PMCID: PMC6834100 DOI: 10.7759/cureus.5866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Foreign body ingestion is a common reason for seeking emergency care among children. One of the more serious foreign bodies are the ingestion of multiple magnets or concurrent ingestion of a magnet and a metallic foreign body. Conservative management with serial imaging can be misleading in such cases. Multiple magnets tend to have strong attractive forces among them and may encase loops of bowel within them. Once entrapped, pressure necrosis and perforation will ensue, and thus, a low threshold should be adopted for surgical exploration in such cases. We present the case of a two-year-old male who had an accidental, unwitnessed ingestion of multiple magnets and also report the subsequent surgical management and associated morbidity.
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Affiliation(s)
- Muhammad Arshad
- Pediatric Surgery, Aga Khan University Hospital, Karachi, PAK
| | | | - Areej Salim
- Pediatric Surgery, Aga Khan University Hospital, Karachi, PAK
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He Y, Zhang W, Sun N, Feng G, Ni X, Song H. Experience of pediatric urogenital tract inserted objects: 10-year single-center study. J Pediatr Urol 2019; 15:554.e1-554.e8. [PMID: 31301975 DOI: 10.1016/j.jpurol.2019.05.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Urogenital tract foreign bodies (FBs) have been rarely reported in children, and the management is still challenging. OBJECTIVE The aim of this study is to review a 10-year experience with urogenital tract FBs in a single center. PATIENTS AND METHODS The authors reviewed the records of children suspected with urogenital tract FBs and first admitted to the hospital, including demographic characteristics, presenting symptoms, methods of diagnosis, and management. The authors compared the surgery strategies in different locations of FBs and age, and the locations of FBs in different age groups. RESULTS Two hundred and thirty-nine cases were reviewed, and 188 were confirmed to retain urogenital tract FBs (150 girls and 38 boys). The number of the patients increased progressively in the last 10 years and mainly concentrated in spring and summer in the last 4 years. The peak ages were 3-5 years old and 9-13 years old. General anesthesia surgeries were performed on 20 patients (Fig. 1). Vagina FBs were more likely to require day surgery, whereas bladder FBs required surgery in hospital. Patients younger than 6 years were more likely to be girls with vagina FBs, and patients older than 11 years were more likely to be boys with bladder FBs. DISCUSSION Urogenital tract FBs in children is a great challenge. As the vagina is shorter and wider than the urethra, girls with vagina FBs are usually treated by day surgery and adolescent boys of urethra FBs are treated by hospital surgery. Misdiagnosis may occur when patients conceal FBs insert history, have severe urinary tract infections, or have previous surgery history. Ultrasonography helps to reduce misdiagnosis. FBs should be taken into consideration when patients have new symptoms after hypospadias repair, and postoperative changes of hypospadias repair, such as urinary calculi, have been excluded. Appropriate surgery techniques, based on the size, nature, and location of FBs, should be performed for complete removal of FBs with minimal complications to reduce secondary injury. Sharp FBs could be migrated among the digestive system, urogenital system, and deep pelvic. If the procedure is difficult, patients with a stable needle can be conservatively managed with close follow-up. Nevertheless, symptomatic patients should be treated actively. CONCLUSION The awareness of potential severity of pediatric urogenital tract FBs should be raised. Appropriate toys and timely sex education help prevent children from urogenital tract FBs insertion. Selecting appropriate techniques for particular situations is the best way to reduce secondary injury, especially for cases with migrated FBs (needles), magnetic FBs, and postoperative FBs.
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Affiliation(s)
- Y He
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - W Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - N Sun
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - G Feng
- Center for Clinical Epidemiology & Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - X Ni
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - H Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Abstract
INTRODUCTION Accidental ingestion of foreign bodies is an increasing problem in the pediatric population. Symptoms are often nonspecific and may lead to a missed diagnosis because the ingestion event often goes unwitnessed. CASE We present a case of a missed diagnosis of a multiple magnet ingestion event in a pediatric patient leading to operative management. A 2-year-old boy with a 4-week history of nonspecific abdominal pain presented to the emergency department (ED) with vomiting and worsening abdominal pain. He was recently seen in the ED for nonspecific abdominal pain diagnosed as acute otitis media. In this second ED visit, the child was found to be febrile and tachycardic and had signs of peritonitis. Radiographs revealed a foreign body in the right lower quadrant. The child was taken to the operating room where multiple intestinal perforations were identified and repaired. The child had an uneventful postoperative course and was discharged 7 days later. DISCUSSION There are increasing awareness and growing concern over complications from pediatric magnet ingestion. Complications from neodymium magnet ingestion may include bowel obstruction, perforation, and fistula formation. The risk of complications is especially high with multiple-magnet ingestion. Pediatric foreign-body magnet ingestion may be a diagnostic challenge because the associated symptoms are nonspecific, and the ingestion is often unwitnessed. CONCLUSIONS Our case represents the missed diagnosis of 4 magnets ingested separately over time. Emergency department providers may benefit from a clinical algorithm guiding the management of these increasingly prevalent patient presentations to prevent delayed diagnoses and to decrease morbidity.
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Miyamoto R, Okuda M, Kaneko K, Numoto S, Okumura A. Multiple Magnets Ingestion Followed by Intestinal Fistula With Mild Symptoms. Glob Pediatr Health 2019; 6:2333794X19855805. [PMID: 31218245 PMCID: PMC6563389 DOI: 10.1177/2333794x19855805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 11/27/2022] Open
Abstract
A healthy 3-year-old boy visited our hospital because of abdominal pain and vomiting, and abdominal X-ray revealed a 10 mm non-sharp foreign body in the lower abdomen. No one had witnessed accidental ingestion. Abdominal symptoms were mild. We followed-up with abdominal X-rays, but the foreign matter did not move. His grandfather remembered that he was playing with a posting magnet. Thus, the foreign matter was considered to be multiple magnets. No foreign body was excreted by laxative administration. There was no foreign matter revealed even by the colonoscopy. Because a fistula was found in the ileum, it was diagnosed as gastrointestinal perforation. Three magnets adhered from inside the fistula were removed by emergency laparotomy surgery. The final diagnosis was ileal sigmoid fistula due to damage of the mucous membrane sandwiched between the magnets. Multiple magnet ingestion often causes gastrointestinal injury. Even if the symptoms are mild, it should be removed promptly.
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Affiliation(s)
- Ryosuke Miyamoto
- Department of Pediatrics, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Masumi Okuda
- Department of Pediatrics, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Kenitiro Kaneko
- Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Nagakute City, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute City, Aichi, Japan
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68
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Mas E, Michaud L, Viala J. Let's stop lesions induced by magnet ingestion. Arch Pediatr 2019; 26:131-132. [PMID: 30833030 DOI: 10.1016/j.arcped.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/20/2019] [Indexed: 11/16/2022]
Affiliation(s)
- E Mas
- Unité de gastroentérologie, hépatologie, nutrition, diabétologie et maladies héréditaires du métabolisme, hôpital des enfants, TSA 70034, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France; IRSD, université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France.
| | - L Michaud
- Division of gastroenterology, hepatology and nutrition, department of paediatrics, faculty of medicine, reference center for chronic and malformative oesophageal diseases, Lille university, children's hospital, 59000 Lille, France
| | - J Viala
- Pediatric gastroenterology department, hopital Robert-Debré, AP-HP, Denis-Diderot faculty, INSERM, 75019 Paris, France
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69
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review clinical manifestations and management of common pediatric foreign body ingestions, with a particular focus on some of the current trends. RECENT FINDINGS Foreign body ingestion (FBI) is a problem that is frequently encountered by pediatric providers. As new toys and products enter the marketplace, there may also be new dangers from those objects not initially recognized. Some of the recent trends and findings in pediatric FBI include an increase in adolescent injury from ingestion of laundry detergent pods because of a popular game where participants are encouraged to bite or swallow the pods, and injuries associated with ingesting parts of a popular toy known as a 'Fidget Spinner'. SUMMARY Adverse events resulting from FBI range the entire gamut from nonexistent or minor symptoms to moderate injury and rarely may be fatal. Factors such as age, type of object ingested, anatomic location of the foreign body, and timing from ingestion to receipt of medical attention all determine the risk posed to the child and guide management decisions. Because of the constant development of products, and the potential for the emergence of new and dangerous trends among children, continued surveillance by the medical community is important in monitoring and managing injuries associated with FBI.
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70
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Nichols G, Yusuf S. A Toddler With Diarrhea and Bloody Emesis Presenting to the Emergency Department. Clin Pediatr (Phila) 2018; 57:1472-1476. [PMID: 29911424 DOI: 10.1177/0009922818780691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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71
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Sola R, Rosenfeld EH, Yu YR, St Peter SD, Shah SR. Magnet foreign body ingestion: rare occurrence but big consequences. J Pediatr Surg 2018; 53:1815-1819. [PMID: 28899548 DOI: 10.1016/j.jpedsurg.2017.08.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To review the outcomes of magnet ingestions from two children's hospitals and develop a clinical management pathway. METHODS Children <18years old who ingested a magnet were reviewed from 1/2011 to 6/2016 from two tertiary center children's hospitals. Demographics, symptoms, management and outcomes were analyzed. RESULTS From 2011 to 2016, there were 89 magnet ingestions (50 from hospital 1 and 39 from hospital 2); 50 (56%) were males. Median age was 7.9 (4.0-12.0) years; 60 (67%) presented with multiple magnets or a magnet and a second metallic co-ingestion. Suspected locations found on imaging were: stomach (53%), small bowel (38%), colon (23%) and esophagus (3%). Only 35 patients (39%) presented with symptoms and the most common symptom was abdominal pain (33%). 42 (47%) patients underwent an intervention, in which 20 (23%) had an abdominal operation. For those undergoing abdominal surgery, an exact logistic regression model identified multiple magnets or a magnet and a second metallic object co-ingestion (OR 12.9; 95% CI, 2.4 - Infinity) and abdominal pain (OR 13.0; 95% CI, 3.2-67.8) as independent risk factors. CONCLUSION Magnets have a high risk of requiring surgical intervention for removal. Therefore, we developed a management algorithm for magnet ingestion. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Richard Sola
- The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO, USA.
| | - Eric H Rosenfeld
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
| | - Yangyang R Yu
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
| | - Shawn D St Peter
- The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO, USA.
| | - Sohail R Shah
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
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72
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Nicoara M, Liu S, Ferzli G. Laws of attraction: management of magnetic foreign body ingestion. BMJ Case Rep 2018; 2018:bcr-2018-225939. [PMID: 29982189 DOI: 10.1136/bcr-2018-225939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Nicoara
- General Surgery, NYU Langone Medical Center, Brooklyn, New York, USA
| | - Shinban Liu
- General Surgery, NYU Langone Medical Center, Brooklyn, New York, USA
| | - George Ferzli
- General Surgery, NYU Langone Medical Center, Brooklyn, New York, USA
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73
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Blevrakis E, Raissaki M, Xenaki S, Astyrakaki E, Kholcheva N, Chrysos E. Multiple magnet ingestion causing instestinal obstruction and entero-enteric fistula: Which imaging modality besides radiographs? A case report. Ann Med Surg (Lond) 2018; 31:29-33. [PMID: 29922465 PMCID: PMC6004778 DOI: 10.1016/j.amsu.2018.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/26/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023] Open
Abstract
Ingested foreign bodies occur in children younger than 3 years and pass uneventfully through the gastrointestinal tract. However, multiple magnet ingestion are associated with serious complications. A 9-year old male with abdominal pain and vomiting 3 days prior to admission, underwent abdominal radiographs showing radiopaque foreign bodies. Ultrasonography (US) independently discovered one magnet floating in the jejunum. Preoperative Computed Tomography (CT) confirmed the presence of two neighbouring magnets causing obstruction and beaking of an adjacent jejunal loop. Laparotomy led to uneventful recovery of transmesenteric fistula formation following pressure necrosis in two jejunal loops. We present the first case of multiple magnet ingestion managed in our institution, where the prevalence of magnet ingestions is low due to unpopularity of magnet toys. CONCLUSION Awareness of the potentially devastating effects of multiple magnets passing the pylorus and the contribution of different imaging modalities for the diagnosis are emphasized and discussed.
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Affiliation(s)
| | - Maria Raissaki
- Dept of Radiology. University Hospital of Heraklion, Crete, Greece
| | - Sofia Xenaki
- Dept of Pediatric Surgery. University Hospital of Heraklion, Crete, Greece
| | | | - Nelli Kholcheva
- Dept of Radiology. University Hospital of Heraklion, Crete, Greece
| | - Emmanuel Chrysos
- Dept of Pediatric Surgery. University Hospital of Heraklion, Crete, Greece
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74
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Foreign body ingestion in children. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000531234.16566.2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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75
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Chao HC, Chang CH, Chan OW. Multiple magnets trapped at the esophagogastric junction of a child. Pediatr Neonatol 2018; 59:205-207. [PMID: 28802629 DOI: 10.1016/j.pedneo.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/04/2017] [Accepted: 07/18/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan District, 33305, Taoyuan City, Taiwan.
| | - Chun-Hsiang Chang
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan District, 33305, Taoyuan City, Taiwan
| | - Oi-Wa Chan
- Division of Critical Care Medicine, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Guishan District, 33305, Taoyuan City, Taiwan
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76
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Commentary: Button Batteries in Fidget Spinners: Is It Time to Push the "Panic Button"? J Pediatr Gastroenterol Nutr 2018; 66:557-558. [PMID: 29369848 DOI: 10.1097/mpg.0000000000001891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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77
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Abstract
Foreign body (FB) ingestion in children is common and most children are observed to be between 6 months and 3 years of age. Although most FBs in the gastrointestinal tract pass spontaneously without complications, endoscopic or surgical removal may be required in a few children. Thus, FB ingestion presents a significant clinical difficulty in pediatric gastroenterological practice. Parameters that need to be considered regarding the timing of endoscopic removal of ingested FBs in children are the children's age or body weight, the clinical presentation, time lapse since ingestion, time of last meal, type as well as size and shape of the FB, and its current location in the gastrointestinal tract. Esophageal button batteries require emergency removal regardless of the presence of symptoms because they can cause serious complications. Coins, magnets, or sharp FBs in the esophagus should be removed within 2 hours in symptomatic and within 24 hours in asymptomatic children. Among those presenting with a single or multiple magnets and a metallic FB that have advanced beyond the stomach, symptomatic children need a consultation with a pediatric surgeon for surgery, and asymptomatic children may be followed with serial X-rays to assess progression. Sharp or pointed, and long or large and wide FBs located in the esophagus or stomach require endoscopic removal.
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Affiliation(s)
- Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
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78
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Holland AJ, Soundappan SS. Trauma hazards in children: An update for the busy clinician. J Paediatr Child Health 2017; 53:1096-1100. [PMID: 28665528 DOI: 10.1111/jpc.13603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/17/2017] [Indexed: 12/29/2022]
Abstract
Trauma and injury continue to be common in children and remain an important cause of mortality and morbidity. Legislation mandating the use of helmets for all cyclists appears to have been effective in reducing the incidence and severity of head and facial injuries, with no clear evidence of a reduction in cycling usage or activity. Straddle injuries, whilst uncommon and generally minor, require careful clinical assessment as they may be associated with urethral trauma. Quad bikes remain highly dangerous with continuing reports of deaths in child riders due to their inherent lack of stability: a ban on their use by children would seem the most effective solution. The popularity of mobile devices and toys, coupled with the development of higher voltage, lithium button batteries have seen a surge in the number of cases and subsequent complications from ingestion. The problems seen in children following ingestion of high-powered, rare earth magnets in the late 1990s and 2000s has now receded due to legislation introduced in 2012. Inhaled, typically organic foreign bodies remain a diagnostic challenge with rigid bronchoscopy still the most effective diagnostic and therapeutic modality. Corrosive ingestion, now seen much less commonly, continues to be a potentially devastating injury when occurring as a result of caustic soda. Recent publicity concerning the problem of childhood drowning highlights the need for constant parental vigilance, the limitations of pool fencing and the importance of community cardiopulmonary resuscitation training, together with repeated education of the risk of rips when swimming in the sea.
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Affiliation(s)
- Andrew Ja Holland
- Douglas Cohen Department of Paediatric Surgery, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Soundappan Sv Soundappan
- Douglas Cohen Department of Paediatric Surgery, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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79
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Bousvaros A. From "Jarts" to "Zen Magnets": Protecting Our Children from Dangerous Toys. J Pediatr 2017; 186:6-7. [PMID: 28372807 DOI: 10.1016/j.jpeds.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 03/03/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Athos Bousvaros
- Division of Gastroenterology, Hepatology, and Nutrition Boston Children's Hospital Boston, Massachusetts.
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80
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Pogorelić Z, Borić M, Markić J, Jukić M, Grandić L. A Case of 2-Year-Old Child with Entero-Enteric Fistula Following Ingestion of 25 Magnets. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 59:140-142. [PMID: 28440218 DOI: 10.14712/18059694.2017.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Magnet ingestion usually does not cause serious complications, but in case of multiple magnet ingestion or ingestion of magnet with other metal it could cause intestinal obstruction, fistula formation or even perforation. CASE REPORT We report case of intestinal obstruction and fistula formation following ingestion of 25 magnets in a 2-year-old girl. Intraoperatively omega shaped intestinal loop with fistula caused by two magnetic balls was found. Intestine trapped with magnetic balls was edematous and inflamed. Resection of intestinal segment was performed, followed by entero-enteric anastomosis. A total of 25 magnets were removed from resected intestine. CONCLUSION Single magnet ingestion is treated as non-magnetic foreign body. Multiple magnet ingestion should be closely monitored and surgical approach could be the best option to prevent or to cure its complications.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, Split University Hospital and University of Split, School of Medicine, Split, Croatia.
| | - Matija Borić
- Department of Surgery, Split University Hospital and University of Split, School of Medicine, Split, Croatia
| | - Joško Markić
- Department of Pediatrics, Split University Hospital and University of Split, School of Medicine, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, Split University Hospital and University of Split, School of Medicine, Split, Croatia
| | - Leo Grandić
- Department of Surgery, Split University Hospital and University of Split, School of Medicine, Split, Croatia
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81
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Abstract
Children inevitably swallow foreign material accidentally or intentionally. Each type of ingestion carries their own set of risks and complications, short and long term, some requiring immediate attention while others close monitoring. Alkalotic household cleaning products and lithium button batteries are increasingly common and damage the esophagus quickly. While many toys with rare-earth metals are banned, they are already present in many households and can cause necrosis of bowel that is between the magnets. This article reviews the incidence and assessment along with current literature to provide guidelines for management of pediatric patients with suspected caustic or foreign body ingestion.
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Affiliation(s)
- Jacob A Kurowski
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, 9500 Euclid Avenue, Dept A111, Cleveland, OH 44195-0001, USA.
| | - Marsha Kay
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, 9500 Euclid Avenue, Dept A111, Cleveland, OH 44195-0001, USA
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82
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Shaffer K, Abbott E, Novotny N. Delayed presentation of rare-earth magnets. J Paediatr Child Health 2017; 53:515-516. [PMID: 28470802 DOI: 10.1111/jpc.13525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/05/2016] [Accepted: 12/31/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Kristina Shaffer
- Department of General Surgery,, William Beaumont Hospital, Royal Oak, Michigan, United States
| | - Emily Abbott
- Department of General Surgery,, William Beaumont Hospital, Royal Oak, Michigan, United States
| | - Nathan Novotny
- Department of Pediatric Surgery, William Beaumont Hospital, Royal Oak, Michigan, United States
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83
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Female Adolescent Presenting With Abdominal Pain: Accidental Wire Bristle Ingestion Leading to Colonic Perforation. Pediatr Emerg Care 2017. [PMID: 26221791 DOI: 10.1097/pec.0000000000000531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Abdominal pain in female adolescents is a common presentation to both the emergency department and the outpatient pediatric clinic. The broad differential diagnosis for abdominal pain requires a high index of suspicion to make an accurate diagnosis of foreign body ingestion as the etiology. Foreign body ingestion occurs in all age groups, but sequelae of gastrointestinal tract perforation in children are rare. Treatment for perforation requires consultation of the pediatric general surgeon. Clinicians should take care to not overlook subtle imaging findings or dietary/exposure history, even in the context of a patient with known history of abdominal pain. CASE REPORT/TECHNIQUE DESCRIPTION We report the accidental ingestion of a wire bristle from a grill cleaning brush by a female adolescent. The patient, previously treated and seen for constipation and irritable bowel syndrome in the outpatient gastroenterology clinic, was referred to the emergency department after identification of a foreign body on abdominal radiography. Emergency department physicians discovered the history of grilling and consumption of grilled food, facilitating diagnosis of a wire bristle as the foreign body. The metallic foreign body had migrated to the colon, where it perforated and lodged into the abdominal wall, causing acute, focal symptoms. Observation in the hospital with pain control and infection management allowed for elective laparoscopy. The surgical team removed the object with minimal morbidity and avoided laparotomy. DISCUSSION Reports of unintended ingestion of wire bristles have been increasingly reported in the literature; however, most focus on injury to the upper airway or upper digestive tract and subsequent endoscopic or laryngoscopic removal. Most reports detail injury in adult patients, pediatric case reports with digestive tract injury are uncommon, and foreign body removal after lower digestive tract injury in children from a wire bristle has not been reported. We caution pediatric emergency medicine and ambulatory providers to consider such an ingestion and perforation in the differential diagnosis of acute-onset, focal, and localizable abdominal pain in children.
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84
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Ilia S, Briassoulis G. Boy With Fever and Abdominal Pain. Ann Emerg Med 2017; 69:515-529. [DOI: 10.1016/j.annemergmed.2016.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Indexed: 11/17/2022]
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85
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Abstract
Magnets are inherently attractive to young children, but present a risk when ingested. If consumed alone, small, smooth magnetic foreign bodies are likely to pass without significant event; however, ingestion of multiple magnets may have catastrophic consequences, including bowel perforation, obstruction, peritonitis, and death. Increasing reports of morbidity and mortality in recent years from the US National Electronic Injury Surveillance System has led to numerous safety statements from the American Academy of Pediatrics and the Centers for Disease Control and Prevention, as well as several product recalls from the Consumer Product Safety Commission. This article presents the background and mechanism of injury of magnet ingestion, as well as recommended management and potential complications. We also review current legislation and opportunities for further patient advocacy regarding this polarizing problem.
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86
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Sekmenli T, Ciftci I. Multiple Intestinal Perforation and Necrosis due to Magnet Ingestion. Eurasian J Med 2016; 48:225-227. [PMID: 28149151 PMCID: PMC5268608 DOI: 10.5152/eurasianjmed.2015.0080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/29/2015] [Indexed: 11/22/2022] Open
Abstract
Among the few foreign bodies swallowed, multiple magnets are very rare. Ingestion of Multiple Magnets may lead to a number of dire complications. The present case report is about the ingestion of multiple singing magnets by 4-year-old child leading to intestinal segmental necrosis and perforations.
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Affiliation(s)
- Tamer Sekmenli
- Department of Pediatric Surgery, Selcuk University School of Medicine, Konya, Turkey
| | - Ilhan Ciftci
- Department of Pediatric Surgery, Selcuk University School of Medicine, Konya, Turkey
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87
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DeFilippis EM, Barfield E, Sockolow R, Kessler E. Bilious Emesis and Small Bowel Obstruction in a Young Male. Clin Pediatr (Phila) 2016; 55:499-501. [PMID: 26156975 DOI: 10.1177/0009922815593910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Elaine Barfield
- New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Robbyn Sockolow
- New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Edmund Kessler
- New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
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88
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Lin JH, Fang J, Wang D, Chen HZ, Guo Q, Guo XG, Han ST, He LP, He SX, Jiang HQ, Jin ZD, Li X, Liao Z, Mei B, Ren X, Tang YJ, Wang BM, Wang L, Xu H, Xu LM, Xue XC, Yang YX, Zhang XF, Zhang ZQ, Zheng HL, Zhi FC, Zhong L, Zou DW, Zou XP, Li ZS. Chinese expert consensus on the endoscopic management of foreign bodies in the upper gastrointestinal tract (2015, Shanghai, China). J Dig Dis 2016; 17:65-78. [PMID: 26805028 DOI: 10.1111/1751-2980.12318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Dong Wang
- Department of Gastroenterology
- Digestive Endoscopy Center
| | - He Zhong Chen
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai
| | - Qiang Guo
- Department of Gastroenterology, First People's Hospital of Yunnan Province, Kunming, Yunnan Province
| | - Xue Gang Guo
- Department of Gastroenterology, Xijing Hospital, Xi'an, Shaanxi Province
| | - Shu Tang Han
- Digestive Endoscopy Center, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province
| | - Li Ping He
- Digestive Endoscopy Center, Fujian Provincial Hospital, Fuzhou, Fujian Province
| | - Shui Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province
| | - Hui Qing Jiang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province
| | - Zhen Dong Jin
- Department of Gastroenterology
- Digestive Endoscopy Center
| | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province
| | - Zhuan Liao
- Department of Gastroenterology
- Digestive Endoscopy Center
| | - Bing Mei
- Department of Emergency Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Xu Ren
- Department of Gastroenterology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang Province
| | - Yong Jin Tang
- Editorial Department of Chinese Journal of Digestive Endoscopy, Nanjing, Jiangsu Province
| | - Bang Mao Wang
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin
| | - Li Wang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai
| | - Hong Xu
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun, Jilin Province
| | - Lei Ming Xu
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai
| | - Xu Chao Xue
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai
| | - Yu Xiu Yang
- Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou, Henan Province
| | - Xiao Feng Zhang
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province
| | - Zi Qi Zhang
- Digestive Endoscopy Center, PLA General Hospital, Beijing
| | - Hong Liang Zheng
- Department of ENT, Changhai Hospital, Second Military Medical University, Shanghai
| | - Fa Chao Zhi
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Liang Zhong
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai
| | - Duo Wu Zou
- Department of Gastroenterology
- Digestive Endoscopy Center
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Zhao Shen Li
- Department of Gastroenterology
- Digestive Endoscopy Center
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89
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Abstract
Esophageal and aspirated foreign bodies have important clinical significance, and both should be considered carefully when the history or physical examination findings raise sufficient suspicion. The published evidence regarding the diagnosis and management of foreign body ingestion or aspiration is weighted disproportionately with observational studies, case controls, expert opinion, and systematic reviews. Most of the publications would receive a categorization of C (observational studies including case-control and cohort design) and D (expert opinion, case reports, and clinical reasoning). One of the few prospective studies examining the diagnostic evaluation of foreign body aspiration in children could be considered level B evidence (randomized clinical trials, systematic reviews, or diagnostic studies with minor limitations). This study found that the medical history is the most important predictive part of the evaluation. There is evidence for considering bronchoscopy if there is significant history suggestive of foreign body aspiration, even in the setting of normal physical examination findings. (28). Most ingested foreign bodies spontaneously pass without incident. However, special attention should be paid to objects in the esophagus as well as to batteries and magnets. Based on a systematic review of the literature (level B evidence) and the potential for rapid and life-threatening damage, batteries in the esophagus should be removed immediately. (10) Other objects, such as coins, may be observed for passage in an asymptomatic patient. In addition, given the high risk of significant complications, ingestion of high-powered magnets should be quickly and carefully evaluated. Although single magnets are likely to pass without complication, multiple magnets or magnets ingested with other metal objects can cause significant damage and should be removed if there is any concern for mural entrapment, bowel perforation, or failure to progress. (10)(16)(17)(18)(19). Lastly, another systematic review of the literature (level B evidence) about the aspiration of food objects in children suggests that this is a significant public health concern with potentially devastating consequences. Despite clear legislation and regulation by the Consumer Product Safety Commission regarding toys, there is no similar regulation of high-risk foods. The data suggest that there is opportunity for improvement in legislation about the production and packaging of high-risk items as well as in the education of caregivers. (22)
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Affiliation(s)
- S Sarah Green
- Pediatrics, Oregon Health & Science University, Portland, OR
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90
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Hodges NL, Denny SA, Smith GA. Rare-Earth Magnet Ingestion-Related Injuries in the Pediatric Population: A Review. Am J Lifestyle Med 2015; 11:259-263. [PMID: 30202341 DOI: 10.1177/1559827615594336] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 12/18/2022] Open
Abstract
Foreign-body ingestions are common among children and usually resolve with limited, if any, treatment. The ingestion of rare-earth magnets, however, commonly results in serious injury or death. These dangerous high-powered magnets can be found in the United States in a variety of consumer products, including magnetic toy sets designed for children and adults. The ingestion of one of such magnet is unlikely to cause significant harm. However, if multiple magnets are ingested, or if a magnet is ingested along with a metal object, the magnets are powerful enough to attract each other through the walls of the intestine, potentially resulting in significant internal damage. Rare-earth magnet ingestion cases are difficult to diagnose and the symptoms are not easy to differentiate from other causes of gastrointestinal illness or pain. However, delays in medical treatment can lead to serious injury or death. This review article describes the epidemiology of rare-earth magnet ingestion-related injuries and provides recommendations for diagnosis and treatment. Federal regulatory efforts related to rare-earth magnets and other prevention strategies are also discussed.
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Affiliation(s)
- Nichole L Hodges
- Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio (NLH, SAD, GAS).,Section of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio (SAD, GAS).,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio (SAD, GAS)
| | - Sarah A Denny
- Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio (NLH, SAD, GAS).,Section of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio (SAD, GAS).,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio (SAD, GAS)
| | - Gary A Smith
- Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio (NLH, SAD, GAS).,Section of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio (SAD, GAS).,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio (SAD, GAS)
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91
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Agarwal J, Deepika G, Razak A, Nagesh NK, Aihole JS, Babu MN, Jagadisan B, Biswal N, Kamate M, Detroja M, Gazali ZA, Singal AK, Jain VG, Gulati R. Macroamylasemia: A benign cause for high serum amylase. Indian Pediatr 2015; 52:533. [DOI: 10.1007/s13312-015-0672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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92
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Abstract
Foreign body ingestions are all too common in children. The adverse effects of many of these ingestions are well known. We present an interesting case report of "Buckyballs" and the implications of ingesting or placing in other orifices these strong rare-earth magnets. We illustrate that these toys can be of possible disastrous consequences. Although these products were removed from the marketplace, there is still the possibility of negative consequences. Our aim was to inform the physician population of their persistence and negative effects.
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93
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Mirza MB, Bux N, Talat N, Saleem M. Multiple singing magnet ingestion leading to pressure necrosis of the small bowel. J Indian Assoc Pediatr Surg 2015; 20:90-1. [PMID: 25829675 PMCID: PMC4360463 DOI: 10.4103/0971-9261.151557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Multiple Magnet ingestion may cause a number of sinister complications. We report a case of multiple singing magnets ingestion by a 2-year-old girl resulting in intestinal obstruction and pressure necrosis of the small bowel. A bunch of seven magnets present in the small bowel was removed operatively.
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Affiliation(s)
- M Bilal Mirza
- Department of Pediatric Surgery, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Nabi Bux
- Department of Pediatric Surgery, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Nabila Talat
- Department of Pediatric Surgery, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Muhammad Saleem
- Department of Pediatric Surgery, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
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94
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Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2015; 60:562-74. [PMID: 25611037 DOI: 10.1097/mpg.0000000000000729] [Citation(s) in RCA: 345] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Foreign body ingestions in children are some of the most challenging clinical scenarios facing pediatric gastroenterologists. Determining the indications and timing for intervention requires assessment of patient size, type of object ingested, location, clinical symptoms, time since ingestion, and myriad other factors. Often the easiest and least anxiety-producing decision is the one to proceed to endoscopic removal, instead of observation alone. Because of variability in pediatric patient size, there are less firm guidelines available to determine which type of object will safely pass, as opposed to the clearer guidelines in the adult population. In addition, the imprecise nature of the histories often leaves the clinician to question the timing and nature of the ingestion. Furthermore, changes in the types of ingestions encountered, specifically button batteries and high-powered magnet ingestions, create an even greater potential for severe morbidity and mortality among children. As a result, clinical guidelines regarding management of these ingestions in children remain varied and sporadic, with little in the way of prospective data to guide their development. An expert panel of pediatric endoscopists was convened and produced the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body ingestions. This guideline is intended as an educational tool that may help inform pediatric endoscopists in managing foreign body ingestions in children. Medical decision making, however, remains a complex process requiring integration of clinical data beyond the scope of these guidelines. These guidelines should therefore not be considered to be a rule or to be establishing a legal standard of care. Caregivers may well choose a course of action outside of those represented in these guidelines because of specific patient circumstances. Furthermore, additional clinical studies may be necessary to clarify aspects based on expert opinion instead of published data. Thus, these guidelines may be revised as needed to account for new data, changes in clinical practice, or availability of new technology.
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95
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Larsen CD, King MA. Case 3: Abdominal pain and vomiting in a 4-year-old boy. Pediatr Rev 2015; 36:132-4. [PMID: 25733766 DOI: 10.1542/pir.36-3-132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Chari D Larsen
- Pediatric Residency Program, University of Utah, Salt Lake City, UT
| | - Marta A King
- Department of Pediatrics, St Louis University School of Medicine, St Louis, MO
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96
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Halleran DR, Karjoo M, Beg MBB, Seeherunvong T. Unrecognized foreign bodies in the gastrointestinal tract of developmentally delayed children: A case series. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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97
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Ingestion de corps étrangers aimantés chez l’enfant : enquête multicentrique française. Arch Pediatr 2015; 22:32-8. [DOI: 10.1016/j.arcped.2014.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/08/2014] [Accepted: 10/17/2014] [Indexed: 12/16/2022]
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98
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Cadena-León J, Cázares-Méndez M, Arguello-Bermeo C, Cervantes Bustamante R, Ramírez-Mayans J. Accidental ingestion of magnets in pediatrics: Emerging health problem. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2015. [DOI: 10.1016/j.rgmxen.2015.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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99
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Cadena-León J, Cázares-Méndez M, Arguello-Bermeo C, Cervantes Bustamante R, Ramírez-Mayans J. Ingestión accidental de imanes en Pediatría: un problema de salud emergente. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2015; 80:113-5. [DOI: 10.1016/j.rgmx.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 02/08/2023]
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100
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Abstract
Rare earth metal magnets (Buckyballs and similar products) remain an important public health risk for children. We report the presentation, course, and treatment of a boy who inserted a string of 30 magnets through his urethra into his bladder and review the diagnostic as well as the therapeutic options for foreign bodies inserted into the pediatric urogenital tract.
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