Magnetic Foreign Body Ingestions

Enteroenteric Fistula: A Rare Sequela of Unwitnessed Magnet Ingestion in a Child

Enteroenteric fistula is an abnormal connection between two loops of bowel, commonly caused by chronic inflammatory disease, malignancy, history of a surgical procedure, radiation, or foreign body ingestion. A previously healthy three-year-old female presented to the Emergency Department in Al Jalila Children's Specialty Hospital, Dubai, UAE, with a one-day history of non-bilious vomiting and colicky abdominal pain. She had no history of fever, loose stools, or bloody stools. On examination, her abdomen was soft, mildly distended, and tender all over, with no palpable masses. She was admitted for one day, improved, and was discharged in good general condition. However, 72 hours later, she presented with the same complaint, and the X-ray of the abdomen showed signs of intestinal obstruction, which were confirmed by an abdominal CT scan. A laparoscopy was performed, showing a band extending from the mid-ileum to the cecum and an enteroenteric fistula between the terminal ileum and cecum. The band was divided, and a laparoscopic-assisted division of the fistula was performed and sutured. She was discharged four days postoperatively in good general condition. On further questioning, the parents mentioned having a missing magnet at home. This case highlights the serious risks of unnoticed magnet ingestion in children, emphasizing the importance of vigilance, prompt evaluation, and intervention to prevent complications, particularly in households with accessible small magnets. To our knowledge, this is the first reported case of an unwitnessed magnet ingestion, which was also not detected by imaging, causing an enteroenteric fistula and subsequently passing unnoticed.

Acute intestinal obstruction caused by gastrointestinal foreign bodies in children: a comparison of laparoscopically assisted approach and open surgery

OBJECTIVE

This study aims to explore the appropriate surgical treatment method for acute intestinal obstruction caused by gastrointestinal foreign bodies in children through a comparison of clinical characteristics in patients treated via laparoscopically assisted approach and open surgery.

METHODS

This study retrospectively analyzed 12 children with acute intestinal obstruction caused by gastrointestinal foreign bodies treated at Shanghai Children's Hospital and Huzhou Maternity and Child Care Hospital from June 2019 to June 2024. Basic information, treatment methods, and prognoses of the patients were collected. General data, operation time, postoperative fasting time, postoperative hospital stay, and intraoperative and postoperative complications were compared between the two groups. Categorical data were compared using Fisher's exact test. Normally distributed continuous data were expressed as mean ± standard deviation and analyzed using an independent samples t-test; non-normally distributed data were expressed as M (P25, P75) and analyzed using the non-parametric Mann-Whitney U test.

RESULTS

Six cases underwent laparoscopic transumbilical extended incision, successfully extracting the intestines and removing the foreign bodies without converting to open surgery. Compared to Six cases undergoing traditional open surgery during the same period, the postoperative fasting time and postoperative hospital stay in the laparoscopic group were 4 (5 ± 3.65) days and 5.5 (5 ± 7.5) days, respectively, while in the traditional open surgery group, they were 5 (4.25 ± 6) days and 6 (5 ± 8.6) days, respectively; the differences were statistically significant (P < 0.05). The laparoscopic group had significantly shorter operation time and faster postoperative recovery. The acceptance of the laparoscopically assisted approach by the families was significantly higher than that of the open surgery treatment.

CONCLUSION

The method of extracting obstructed intestines and removing foreign bodies via laparoscopic-assisted transumbilical extended incision has advantages over open surgery for treating acute intestinal obstruction caused by gastrointestinal foreign bodies, such as shortening hospital stay and operation time. However, for children with secondary gastrointestinal perforation caused by magnetic foreign bodies, open surgery, due to its broader exploration scope, is more advantageous for detecting occult perforations.

"Signet Ring Sign" on Plain X-ray Indicates the Need for Surgical Intervention After Magnet Ingestion in Children

The ingestion of magnets used in toys and household products is a common problem in children and can have potentially devastating health consequences. The attraction between multiple magnets across intestinal walls can lead to bowel obstruction, fistula formation, necrosis, and perforation of the involved segments. Multiple magnets attached to each other within the intestinal lumen can also pass spontaneously. Clinical and radiological findings help guide the clinician in deciding whether to intervene surgically or follow an expectant management plan. We report the radiological finding of a "signet ring" on a plain abdominal X-ray that was associated with the surgical finding of fistula formation in two patients, who had clinically benign exams after magnet ingestion. This finding on plain abdominal X-rays should warrant operative exploration in children after magnet ingestion.

Magnetic foreign body ingestion in pediatric age

OBJECTIVES

To assess the clinical complications reported after the ingestion of magnetic foreign bodies (FBs) in pediatric age, along with their incidence among all FB ingestions and clinical presentation.

STUDY DESIGN

We've consecutively recruited all children aged 0-14 years who were admitted for single or multiple magnet ingestion from May 2015 to December 2022. Patient demographics, admission sources and discharge status were accurately recorded, along with their clinical management and outcomes.

RESULTS

Sixty-one children were enrolled, of whom 49/61 (80.3%) had ingested a single magnet and 12/61 (19.7%) multiple magnets. Only 1/49 children with single magnet required endoscopic removal due to esophageal retention. Among children having ingested multiple magnets, 5/12 (41.7%) undergo endoscopic removal since magnets were amenable to endoscopic retrieval whereas in 7/12 (58.3%) magnets could not be promptly removed. Among these, 4/12 (33.3%) later developed intestinal ischemia/necrosis or perforation and required FB surgical intervention whereas 3/12 (25%) uneventfully evacuated magnets.

CONCLUSIONS

Our data confirm that multiple magnet ingestion, unlike single magnet ingestion, pose a serious health hazard. Parents and caregivers should remove them from the reach of children. Medical providers should maintain a high index of suspicion of their ingestion since prompt evaluation and likely removal may be lifesaving and intestine saving.

Safety beyond Sight: Handheld Metal Detectors as Diagnostic Allies in the Management of Children Suspected to have Ingested Foreign Bodies

BACKGROUND

Foreign body (FB) ingestion remains a common cause of pediatric emergency department referrals, and the gold standard for detection is whole-digestive-tract radiographic examination. Our study explores whether handheld metal detectors (HHMD) can effectively identify the presence and location of ingested metal objects, potentially reducing the need for additional radiographic examination.

METHODS

We collected medical data from children with suspected metal FB ingestion who were referred to our emergency department (October 2017-March 2023), focusing on object type and correlating metal detector findings with radiographic images.

RESULTS

Data from 43 children (39.5% female; mean age: 4 y) referred to our emergency department were analyzed. Coins (32.6%), button batteries (18.6%), and hairpins (11.6%) were the most common ingested objects. Metal detectors detected the presence of FBs in 81.4% of cases (sensitivity: 89.7%; specificity: 100%). Radiographs, taken for 40 children, showed that the most common locations were the stomach (37%) and intestine (33%). The metal detector signals matched the radiography results in 69.8% of cases. According to HHMD, 34.9% of objects were accessible via endoscopy, contrasting with 51.2% via radiography (p < 0.05).

CONCLUSION

While the findings obtained using handheld metal detectors often correlate well with radiograph findings in detecting metal FBs, for an important number of children, this confirmation is lacking, especially when determining the exact location of an object.

Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper

Magnet ingestion is a special category of foreign body ingestion associated with high levels of morbidity and mortality worldwide, particularly if it is associated with staggered ingestion of multiple magnets or with simultaneous ingestion of other metallic foreign bodies, especially button batteries. A special category of magnet ingestion is the ingestion of earth magnets, which have higher levels of magnetism and therefore, potentially, carries a worse outcome. Legislative bodies, scientific Societies and community-led initiatives have been implemented worldwide with the aim of mitigating the effects of this growing, yet avoidable potential medical emergency. A scoping literature review summarized epidemiology, diagnosis, management, and prevention, including an algorithm for the diagnosis and management of magnet ingestion is presented and compared to previously published reviews and position papers (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, National Poison Center, Royal College of Emergency Medicine). The main emphasis of the algorithm is on identification of staggered/multiple magnet ingestion, and early joint gastroenterology and surgical consultation and management.

Foreign body ingestion: Is intervention always a necessity?

Introduction

Intentional and accidental foreign body ingestion are commonly encountered in clinical practice. In adults, intentional foreign body ingestion is frequently observed among individuals with psychiatric disorders and prisoners. Controversies exist regarding the management of sharp or pointed objects. We contribute to this existing controversy by presenting a case of a 43-year-old male who accidently ingested a metallic screw and was managed successfully through endoscopic retrieval.

Case presentation

We discuss a case of a 43-year-old male presented to our emergency department after accidently swallowing a metallic screw, 1 h and a half prior to his presentation. He was initially asymptomatic then started to complain of vague abdominal symptoms. X-rays of the chest and abdomen demonstrated the presence of a metallic screw at the mid-abdomen. Computed tomography scan of the abdomen then confirmed its presence within the gastric lumen, with no evidence of gastric or bowel perforation. The patient was managed via esophagogastroduodenoscopy in which the ingested screw was extracted. He was discharged after 24 hours in a good condition.

Clinical discussion

A limited number of epidemiological studies have shed light on the prevalence and incidence of foreign body ingestion among adult individuals. Probability of spontaneous passage depends on several factors including the size, shape and composition of the impacted item, as well as the age of patient and duration of ingestion prior to presentation.

Conclusion

Considering the variation of ingested objects and the availability of several therapeutic approaches, a patient-tailored management plan should always be established.

Multicentre study of magnet ingestion in Spanish paediatric emergency departments

INTRODUCTION

The ingestion of magnetic objects can cause complications in children, and there are no epidemiological or clinical data on the subject in Spain.

OBJECTIVES

To determine the incidence, epidemiological characteristics and management of magnet ingestion in paediatric emergency departments in Spain.

MATERIAL AND METHODS

Prospective observational multicentre study conducted over a 3-year period. The study universe consisted of patients aged less than 14 years.

RESULTS

The incidence was 4.8 cases per 100 000 emergency care episodes. Of the 72 patients included (mean age, 7.2 years), 54% were male. Seven percent had neuropsychiatric disorders. Sixty-one percent of the magnets were spherical and 69% came from toys. The size was variable, most frequently between 5 and 10 mm (50%), and ranging from 3 to 30 mm. Eighty-six percent of patients were asymptomatic. The most frequent symptom was abdominal pain. Eighty-three percent of the patients sought medical care within 6 h of ingestion and 92% within 24 h. Thirty-one percent of the cases were of multiple ingestion. Endoscopy was required for extraction in 15% of cases, a proportion that rose to 36% in the group of cases of multiple ingestion. None of the patients required surgery. We did not observe any gastrointestinal complications of magnet ingestion.

CONCLUSIONS

The ingestion of multiple magnets is less frequent than single magnet ingestion, and we did not observe any complications despite the lower frequency of procedures compared to other studies.

Ingested Foreign Bodies Can Cause Appendicitis and Perforation: A Multi-Institutional Case Series

INTRODUCTION

Appendicular foreign bodies are a rare, under-described cause of appendicitis. We performed this study to determine the varied causes and consequences of foreign-body appendicitis.

METHODS

On retrospective review of the pathology archives of seven institutions, we identified 56 appendix specimens containing a foreign body (defined as ingested, non-digestible material). We recorded the type of foreign body, patient age and sex, and other findings, as available.

RESULTS

Mean patient age was 7.7 years (range: 1 day-18 years). The foreign bodies included hair, plant material, magnets, other metallic material, BB pellets, foreign material not otherwise specified, and other miscellaneous objects. Of 48 cases with available clinical information, 31 patients presented with abdominal pain, and 22 were preoperatively diagnosed as having appendicitis/appendicular inflammation. Seven patients had appendiceal perforation (13%). The foreign body was grossly identified in 34/47 cases with available gross descriptions. Twenty-seven cases had an identifiable foreign body microscopically; 10 were associated with giant cell reaction.

DISCUSSION

Hair and plant materials were the most common foreign objects found in the appendix; they often cause mucosal damage and giant cell reaction. Metallic objects were less common. Although appendicular foreign bodies in children are rare and sometimes asymptomatic, they may lead to perforation.

Pediatric Multiple High-Powered Magnetic Buckyballs Ingestion—Experience From Six Tertiary Medical Centers

Multiple high-powered magnetic Buckyball ingestions may lead to a high risk of severe complications. Great concerns have been raised by public health workers, and it remains challenging for clinicians to solve this troublesome problem. We report a large case series of children with Buckyball ingestion from six tertiary medical centers. The clinical data, including demographics, medical history, diagnosis tools, management options, intraoperative or endoscopic findings, and outcomes, were retrospectively analyzed. Seventy-one children aged 1–13 years ingested 2–41 Buckyballs. Among them, Buckyballs passed spontaneously on 2–10 days post-ingestion in seven cases; gastroscopic removal was performed in 14 cases; laparoscopic removal in 13 cases; laparoscopic-assisted surgical removal in 6 cases; and open surgical removal in 31 cases. Surgical indications included small bowel obstruction, perforation, peritonitis, acute abdominal pain, or along with ingestion of other metallic foreign bodies. Among those who underwent a surgical procedure, primary intestinal repair was performed in 44 cases, enterectomy with primary anastomosis in 6 cases. The postoperative hospital stay ranged from 5 to 28 days. No major complications occurred. In unwitnessed cases, a vague medical history and nonspecific symptoms usually make the diagnosis difficult. The treatment options should include the watch-and-wait approach, endoscopic, laparoscopic-assisted, or open surgical removal of Buckyballs, with primary intestinal repair or anastomosis. Preventive measures, including children's not having access to Buckyballs, are essential to protect children from this kind of unintentional injury.

Point-of-Care Ultrasound to Evaluate the Acute Abdomen: A Case of Bowel Perforation After Unknown Single Magnet Ingestion

ABSTRACT

We report the case of a 3-year-old boy who presented to the pediatric emergency department in undifferentiated shock with an acute abdomen. Point-of-care ultrasound revealed viscous perforation with a large amount of free fluid. Intraoperatively, a single magnet was discovered as the likely cause of bowel perforation and the resulting state of shock.

Epidemiology of Pediatric Foreign Body Ingestions Amidst the Coronavirus 2019 Pandemic at a Tertiary Care Children’s Hospital

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Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the paediatric population: Part 2

Children, especially toddlers, because of their behaviour, physiology and anatomical characteristics such as oral exploration of their surroundings, have a tendency to place objects in their mouth. Therefore, ingestion or aspiration of foreign bodies (FBs) in children is a potentially life-threatening and common problem seen across the world. In this second part of our pictorial review on ingested and aspirated FBs, we focus on the paediatric population, reviewing the current literature and examining the epidemiology, clinical presentation, anatomic considerations, appropriate imaging modalities, key imaging characteristics associated with clinically relevant FBs in the emergency department (ED) and current management protocols.

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.

Magnet Ingestion in Children Management Guidelines and Prevention

Purpose: Foreign body ingestion is common in children, and most foreign bodies pass spontaneously without causing serious injuries. Ingestion of multiple high-power magnet pieces is unique and increases the risk of morbidity and mortality. The longer the duration of ingestion, the increased likelihood of complications. Various management options have been reported, and there is no consensus on the ideal management which necessitates the need for a practical algorithm. The incidence of magnet ingestion has been increasing and directly related to the laws and recalls. The aim of this review is to provide an easy and practical pathway for management and to highlight the preventive rules of the legislations and recalls. Methods: PubMed/MEDLINE, the Cochrane Database of Systematic Reviews, and the list of references from all identified complete publications were searched for all publications in English-language for pediatric magnet ingestion. Conclusion: Practical and time-saving management pathways are recommended to minimize the risk of complications. Preventive rules and recalls are important for eliminating the availability of these hazardous magnets. Public awareness about the unique risks posed by these magnets if ingested is important.

Magnetic compression anastomosis for rectal atresia following necrotizing enterocolitis: A case report

RATIONALE

Rectal atresia caused by necrotizing enterocolitis (NEC) is a serious and rare complication in children. Magnetic compression anastomosis (MCA) has been effectively applied in children with congenital oesophageal atresia and biliary atresia. Herein, we reported a case of successfully application of MCA in an infant with rectal atresia following NEC.

PATIENT CONCERNS

A 30 weeks premature birth female fetal infant was transferred to our neonatal intensive care unit due to premature delivery, low birth weight, and neonatal respiratory distress. On postpartum day 11, the infant developed abdominal distension and mucosanguineous feces. This infant was then clinically diagnosed as NEC. She underwent anesthesia and intestinal fistula operation on postpartum day 11 because of NEC.

DIAGNOSIS

After 3 months, radiographic examination revealed rectal atresia and stricture.

INTERVENTIONS

This infant was successfully treated with MCA following a cecum-rectal anastomosis and ileocecal valve was reserved.

OUTCOMES

On postoperative day 9, she passed the 2 magnets per rectum. In addition, there were no difficult defecation or fecal incontinence or other short-term complications. After the 7-month follow-up, the patient had an excellent clinical outcome.

LESSONS

MCA is a feasible and effective method for treating rectal atresia in infants.

Constant magnetic field in treating congenital esophageal and anorectal malformation: a review

Background

Congenital esophageal and anorectal malformation are common in neonates. Refractory esophageal anastomotic stricture and abnormal defecation after surgical correction in infants are challenging surgical problems. Magnetic compression anastomosis (MCA) using mated magnets with their interposed compressed tissue may result in serosa-to-serosa apposition.

Data sources

A literature search was performed to establish an algorithm for these accidents by the authors to identify relevant articles published from 1977 to 2019 in Google, Medline, ISI Web of Knowledge Ovid, CNKI and library document delivery, using search terms “magnetics”, “esophageal malformation”, “anorectal” and “perforation”. A total of 24 literatures were collected.

Results

Magnamosis is technically feasible for alimentary tract anastomoses in pediatric patients. The magnets are most commonly made of neodymium–iron–boron and samarium–cobalt alloys, which have been employed to create solid anastomosis for long-gap esophageal atresia and refractory esophageal stricture without thoracotomy in children in recent years. Furthermore, magnamosis can be used for the functional undiversion of ileostomy. In anorectal malformations with favorable anatomy, this procedure may avoid an operative repair such as posterior sagittal reconstruction.

Conclusion

Translumenal anastomosis of digestive tract using the MCA is a reliable, minimally invasive and feasible method to treat congenital esophageal and anorectal malformation.

Ball Magnets Clicked Together on the Epiglottis

Neodymium ball magnets are commonly ingested by children and are a risk of causing significant morbidity if not addressed appropriately. While most ingested magnets are located distal to the epiglottis in the gastrointestinal tract, they can rarely get lodged across tissues in the mouth and throat such as the epiglottis. Though rare, this represents an impending airway emergency and requires urgent treatment once identified. We present the case of a two-year-old, asymptomatic male who presented after ingesting two neodymium ball magnets that were found to be clicked together across his epiglottis, which were ultimately retrieved by bronchoscopy without complications.

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.

Multiple Magnet Ingestion leading to Bowel Perforation: A Relatively Sinister Foreign Body

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.

[Radiological evaluation of acute abdomen in children]

CLINICAL/METHODICAL ISSUE

Acute, non-traumatic abdominal pain is one of the main reasons for medical consultation in pediatric patients. Knowledge of different diseases and their age dependence is essential for correct diagnosis and treatment.

STANDARD RADIOLOGICAL METHODS

Ultrasonography is the imaging method of choice. X‑ray is only used in case of emergency, e. g., suspected perforation.

METHODICAL INNOVATIONS

Contrast-enhanced ultrasonography (CEUS) and elastography complement ultrasonography.

PERFORMANCE

Magnetic resonance imaging is of increasing relevance for differential diagnosis of unclear sonographic results.

PRACTICAL RECOMMENDATIONS

The primary imaging modality in pediatric patients is ultrasonography. Cross-sectional imaging should only be used in cases of unclear sonographic findings.

Successful removal of multiple magnetic foreign bodies in the digestive tract of children by gastroscopy: Two case reports

RATIONALE

Gastrointestinal foreign body (FB) is an emergency commonly encountered by the pediatric gastroenterology department. Management of their extraction requires knowledge and careful consideration of removal techniques.

PATIENT CONCERNS

Two little girls swallowed multiple magnets that stuck together for >3 days, which was an indication for surgery.

DIAGNOSIS

X-ray revealed dense shadows in the left abdomen. However, the abdominal examination revealed a soft abdomen without tenderness, rebound tenderness, or muscle rigidity.

INTERVENTION

The multiple magnets were removed by endoscopy instead of surgery.

OUTCOME

We conducted sufficient preoperative assessment and preparation. Eventually, we successfully removed the multiple magnets by endoscopy, and no perforation or fistula formation was observed. Surgery was avoided.

LESSONS

Swallowing multiple magnets isn't a rare emergency in children. Physicians must be aware that surgery is not the only option even if multiple magnets are swallowed for >12 hours. Endoscopic removal can be considered if there is no obstruction, perforation, or fistula formation upon careful patient assessment. If endoscopic removal fails, surgical treatment should be performed as soon as possible to avoid serious complications.

Magnetic Foreign Body Ingestion in Children: The Attractive Hazards

Foreign body ingestions are frequent in the childhood population. Most foreign bodies are passed spontaneously through the gastrointestinal tract. However, on occasion, they can also be a rare cause of morbidity and even mortality, such as in the case of multiple magnetic foreign body ingestion, which can cause injury via magnetic attraction through bowel walls. We present two cases of multiple magnetic foreign body ingestion, which to our knowledge are the first ones reported in Hong Kong. One patient presented with shock and intestinal necrosis requiring extensive intestinal resection, whereas the other patient had no gastrointestinal injury but surgical removal was deemed necessary.

Ileocecal junction perforation caused by a sewing needle in incarcerated inguinal hernia: An unusual case report

INTRODUCTION

This case study is concerning the meticulous observation of the moving process and track of 2 ingested needles using interval x-ray radiography, trying to localize the foreign bodies and reduce unnecessary exploration of digestive tract.

CASE PRESENTATION

An unusual case of a 1-year, 9-month-old female baby, with incarcerated hernia perforation caused by sewing needles with sharp ends, was reported herein. The patient had swallowed 2 sewing needles. One needle was excreted uneventfully after 8 days. On the contrary, the other needle stabbed the ileocecal junction wall into the right side of inguinal hernia sac after 9 days, and the patient received successful operation management. Interval x-ray confirmed that 1 needle-like foreign body moving down in 8 days until excretion along with feces. However, the other pierced into the incarcerated hernia. Preoperative x-ray radiography successfully monitored the moving process and tract of the sewing needles. Considering the penetrating-migrating nature of the foreign bodies, once the sharp-pointed objects were located, they should be removed as the mortality and risk of related complications may be increased.

CONCLUSION

Interval x-ray radiography represents a meticulous preoperative monitoring method of the moving process and tract of needle-like foreign bodies. Interval x-ray with real-time images accurately detecting the moving foreign bodies could be help to reduce the unnecessary exploration of digestive tract and subsequently prevent possible complications. Based on the basic findings from the interval x-ray, treatment choices of endoscopic removal and surgical intervention may be attempted.