Upper aerodigestive magnetic foreign bodies in children

Survey of pharyngeal foreign bodies in Japan: An ecological study using the nationwide claims data

OBJECTIVE

Pharyngeal foreign bodies (PFBs) are a prevalent disease affected by food culture and dietary habits, with fish bones as the leading cause. Most studies were limited to specific regions, and a nationwide survey was not conducted in Japan. In this ecological study, we aimed to conduct a nationwide analysis of outpatient PFB cases in Japan over three years, focusing on seasonal trends, sex- and age-stratified cases, and regional differences.

METHODS

We used the National Database of Health Insurance Claims and Specific Health Checkups of Japan open data from April 2019 to March 2022. The case data were analyzed by month, age, sex, and prefecture. Additionally, we calculated the standardized claim ratios (SCRs) for each prefecture and investigated the association between dietary habits, food culture, and SCR of PFBs using a two-level linear regression model.

RESULTS

We analyzed a total of 164,337 outpatient PFB cases in Japan, revealing an average incidence rate of 45.6 per 100,000 persons. The seasonal trend revealed a peak in July each year from 2019 to 2021, confirming seasonality in PFB incidents. Children reported a higher incidence rate. Living west of Japan and expenditure on fish and shellfish had a strongly positive association with the SCR of PFBs.

CONCLUSION

Our nationwide survey reveals that, even within Japan, there were regional variations influenced by food culture and dietary habits. The data showed that PFB incidence was higher among children, highlighting the need for preventive education.

LEVEL OF EVIDENCE

Level 3.

High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study

BACKGROUND AND OBJECTIVES

High-powered magnets were effectively removed from the US market by the Consumer Product Safety Commission (CPSC) in 2012 but returned in 2016 after federal court decisions. The United States Court of Appeals for the 10th Circuit cited imprecise data among other reasons as justification for overturning CPSC protections. Since then, incidence of high-powered magnet exposure has increased markedly, but outcome data are limited. In this study, we aim to describe the epidemiology and outcomes in children seeking medical care for high-powered magnets after reintroduction to market.

METHODS

This is a multicenter, retrospective cohort study of patients aged 0 to 21 years with a confirmed high-powered magnet exposure (ie, ingestion or insertion) at 25 children's hospitals in the United States between 2017 and 2019.

RESULTS

Of 596 patients with high-powered magnet exposures identified, 362 (60.7%) were male and 566 (95%) were <14 years of age. Nearly all sought care for magnet ingestion (n = 574, 96.3%), whereas 17 patients (2.9%) presented for management of nasal or aural magnet foreign bodies, 4 (0.7%) for magnets in their genitourinary tract, and 1 patient (0.2%) had magnets in their respiratory tract. A total of 57 children (9.6%) had a life-threatening morbidity; 276 (46.3%) required an endoscopy, surgery, or both; and 332 (55.7%) required hospitalization. There was no reported mortality.

CONCLUSIONS

Despite being intended for use by those >14 years of age, high-powered magnets frequently cause morbidity and lead to high need for invasive intervention and hospitalization in children of all ages.

Nearly missed laryngeal foreign body

Foreign body ingestion and aspiration can present as a life-threatening emergency in children. These foreign bodies are diagnosed based on history, physical exam, and focused radiography to reduce the risk of excessive radiation. We describe a case of a 3-year-old child who ingested magnetic beads and presented to the emergency department with no symptoms. On a single view x-ray of chest and abdomen, the magnetic beads were identified in the abdomen but a closer look at these single view x-rays raised a suspicion of additional foreign bodies in the larynx. A dedicated x-ray of the neck identified 2 more magnetic beads locked with each other on either side of the epiglottis. These laryngeal magnetic beads were nearly missed on initial x-rays, especially because the child had no symptoms of upper airway obstruction. This case report provides further evidence that in the evaluation of radiopaque foreign bodies in children we should strongly consider "nose to rectum" x-rays.

Foreign body esophagus in a young infant

Unattended children, mostly from low-socioeconomic contexts, who present with sudden onset obstructive respiratory and/or gastrointestinal symptoms, should be at high suspicion for foreign body ingestion. Prompt diagnosis helps avoid mismanagement and can potentially avoid dire outcomes.

Small Rare Earth Magnets Adhered to Pharyngeal Tissue in a Pediatric Emergency Department Patient

BACKGROUND

Small rare earth magnets pose a known health risk to children and many cases of ingestion and aspiration with associated complications have been described. More unusual, but also seen in children, are retained foreign bodies in the oropharynx that require extraction.

CASE REPORT

We present the case of a 3-year-old boy with persistent left-sided sore throat 1 h after ingestion of several 3-mm spherical rare earth magnets. No foreign bodies were visible in the oropharynx on examination; however, a chest radiograph revealed two adjacent magnets within the lower pharyngeal space, as well as four magnets linearly clumped within the small intestine. The patient was taken to the operating room, where visual inspection under general anesthesia revealed two magnets adhered to the pharyngoepiglottic folds (one on the laryngeal surface and one on the glottic surface). They were removed in full without issue, preventing aspiration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given the recent increase in incidence of rare earth magnet ingestion, emergency providers ought to be aware of the risks and complications associated with magnetic foreign body ingestion in children and the workup and considerations involved in their removal. Providers should also advocate for improved safety controls of these products, which have been found to be effective in the past.

Use of an intraocular handpiece for the removal of magnets from the oropharynx of a pediatric patient

With the increasing availability of magnets within household objects and toys, otolaryngologists must be aware of the propensity of ingestions or impaction of magnets within the upper aerodigestive tract of pediatric patients. We describe a case of a 21-month old male who presented with throat pain after swallowing ten 0.5-inch magnetic balls, after which evaluation revealed the adherence the the of three magnets within the posterior oropharynx and an additional seven magnets in the small intestine. After an initial failed attempt to remove the pharyngeal magnets with forceps, the magnets were successfully removed using an ophthalmic intraocular magnet handpiece designed for ophthalmologic procedures. Use of this device should be taken into consideration for similar cases.

Multicenter investigation of pediatric gastrointestinal tract magnets ingestion in China

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.

Magnetic Apposition across the Epiglottis: Radiographic and Operative Correlation of a Rare Hypopharyngeal Foreign Body

Background and Aim. Rare-earth magnet ingestions are a subset of foreign body ingestions and can result in significant morbidity secondary to pressure necrosis. These magnets are best visualized radiographically, typically located in the gastrointestinal tract. However, unusual locations of magnetic adherence may include the hypopharynx along the epiglottis, where only 2 previous cases have been reported. Clinicians should be aware of the potential dangers of rare-earth magnet ingestion and consider atypical locations of attachment in the appropriate clinical setting. Case Presentation. We present an interesting case of a fourteen-year-old female patient who presents with witnessed ingestion of multiple rare-earth magnets. Soft-tissue neck radiographs demonstrate two adjacent rounded radiopaque densities in the hypopharynx. Intraoperative images confirmed the radiographic findings and identified two magnetic balls stuck along the dorsal and ventral aspect of the epiglottis without evidence of pressure necrosis.

Prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with foreign body ingestion

BACKGROUND

Foreign body ingestion is a common condition in children. We aimed to compare the incidence of attention deficit hyperactivity disorder (ADHD) symptoms in children that ingested foreign bodies with healthy children.

METHODS

The study group consisted of 3- to 17-year-old pediatric patients admitted to the emergency department after foreign body ingestion, and the control group was formed with children having similar demographic and cultural characteristics that presented to the same department for non-traumatic causes. After initial intervention and stabilization, we administered the Conners' Parent Rating Scales-Revised (CPRS-R) to both groups.

RESULTS

The study group consisted of 53 patients with a mean age of 7.83 ± 4.36 and the control group comprised 47 children with a mean age of 7.72 ± 3.48 years. There were no statistically significant differences between the study and control groups in terms of age, gender, and parental education levels (p > 0.05 for each). The foreign objects most ingested by children were coins (32.1%), followed by needles (15.1%) and beads (9.4%), and all the patients recovered without complications and were discharged. All the CPRS-R subscale scores were significantly higher in the study group than in the control group (p < 0.001). The parental education levels of the study group were not significantly correlated with DSM-IV hyperactivity-impulsivity and DSM-IV total.

CONCLUSION

We found that the incidence of ADHD symptoms may be high in children referred to emergency services after accidentally ingesting foreign bodies.

Temporal and regional trends of choking injuries in children in Italy, 2001-2013

BACKGROUND

Choking injuries in children are a significant public health problem. The present study was aimed at examining the epidemiologic patterns of choking injuries in children using Italian official data from hospital discharge records.

METHODS

Hospital discharge records (from 2001 to 2013) reporting cases of choking injuries corresponding to the ICD-9 CM codes 933 ("Foreign body in pharynx and larynx"), 934 ("Foreign body in trachea, bronchus, and lung"), and fourth digit specifications (933.0 "pharynx", 933.1 "larynx", 934.0 "trachea", 934.1 "main bronchus", 934.8 "other specified parts", 934.9 "respiratory tree, unspecified") occurred in children aged 0-14 years were analyzed to assess the temporal and regional trends. Annual rates of hospitalizations due to choking injuries per 100,000 person-years were calculated and compared between boys and girls.

RESULTS

During the 13-year study period, there were a total of 7143 hospitalizations due to choking injuries in Italian children. The annual rates of hospitalizations due to choking injuries per 100,000 person-years decreased from 5.28 in 2001 to 3.46 in 2013 (p < 0.001). The reduction in choking injuries occurred across all the regions, particularly in Campania, Lombardia, Puglia, and Veneto.

CONCLUSIONS

Hospitalizations for choking injuries in Italian children have decreased significantly in recent years. Choking injuries in children remain a cause of concern in some regions. Future research needs to elicit the causal factors underlying the downward trends and regional variations and develop targeted interventions to further reduce choking injuries in Italian children.

Multiple Magnetic Foreign Bodies Causing Severe Digestive Tract Injuries in a Child

Foreign body (FB) ingestion is a common emergency as well as a major cause of accidental injury and represents a severe public health problem in childhood, especially in infants. Most cases of FB ingestion reported in children aged between 6 months and 3 years depend primarily on the fact that young children are more likely to explore objects using their mouth and are not able to distinguish edible objects from nonedible ones, their teeth are physiologically lacking, and they have poor swallowing coordination. Although, sometimes it can cause serious complications, FB ingestion generally has a low mortality rate. However, accidental ingestion of magnetic toys, as a rare kind of FB mostly encountered in children, has now become more common due to the increased availability of objects and toys with magnetic elements. The majority of magnetic FB traverse the gastrointestinal (GI) system spontaneously without complication, but in rare cases may cause severe damages to the GI tract due to its special pathogenesis [Kay and Wyllie: Curr Gastroenterol Rep 2005;7: 212-218]. Ingestion of multiple magnets may be related to increased morbidity resulting in a delay of recognition of FB injury that can lead to serious complications and require surgical resolution.

Magnetic Foreign Body Ingestions

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.