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Khader J, De Loizaga E, Johns A, Wieck M. Paediatric magnet ingestion persists worldwide despite increasing regulatory policies. Inj Prev 2025:ip-2024-045545. [PMID: 40393707 DOI: 10.1136/ip-2024-045545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 02/12/2025] [Indexed: 05/22/2025]
Abstract
OBJECTIVE Paediatric magnet ingestion can have devastating consequences. To minimise this risk, many countries have policies to reduce exposure. This study seeks to summarise global reports of paediatric magnet ingestion and stringency of corresponding national policies. STUDY DESIGN A comprehensive literature search was conducted in English and Spanish using PubMed, Google Scholar, Scopus, Virtual Health Library, Clarivate-Web of Science, and Latin American and Caribbean Health Sciences Literature. Included papers documented magnet ingestion in ages 0-18 years, from 2002 to 2024. Non-magnet foreign body ingestions were excluded. Policy searches were conducted online in English and Spanish. In total, 2998 articles were reviewed, with 204 papers undergoing full-text analysis. Data regarding incidence, demographics, and interventions required were extracted. RESULTS A total of 96 studies from countries in six continents documenting patients requiring hospitalisation and/or medical interventions were included. Studies reported between 1 and 5738 cases over a range of years, with several studies showing an increase in incidence over time. National policies placing warning labels, restricting sales, or banning high-powered magnets were described mostly in Western nations within the last 5 years. CONCLUSION Paediatric magnet ingestion incidence rates remain high despite an increase in regulations globally. Reported data likely underestimates the true extent of the problem since relevant reports are not available in many countries and many countries still lack national policies or data comparing pre- and post-policy implementation. There is insufficient data to determine the efficacy of any single type of regulation.
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Affiliation(s)
- Javeria Khader
- School of Medicine, UC Davis Health, Sacramento, California, USA
| | | | - Alexandra Johns
- General Surgery, UC Davis Health, Sacramento, California, USA
| | - Minna Wieck
- Pediatric Surgery, UC Davis Health, Sacramento, California, USA
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Luo Y, Cui X, Zhou J, Zhuang Y, Zheng C, Su Q, Gan Y, Li Z, Zeng H. Development and Validation of a Clinical Nomogram for Predicting Complications From Pediatric Multiple Magnet Ingestion: A Large Retrospective Study. Am J Gastroenterol 2025; 120:642-649. [PMID: 39287501 PMCID: PMC11864049 DOI: 10.14309/ajg.0000000000002983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/22/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION This study aimed to develop and validate a reliable nomogram based on clinical factors to predict complications associated with pediatric multiple magnet ingestion, addressing the urgency and controversy surrounding its management. METHODS Patients aged 0-18 years with multiple magnet ingestion diagnosed at the Shenzhen Children's Hospital between January 2017 and December 2023 were enrolled. Clinical data were analyzed using least absolute shrinkage and selection operator regression and multifactor logistic regression analyses to screen for risk factors. A model was constructed, and a nomogram was plotted. Model performance was evaluated and internally validated using the area under the curve (AUC), Hosmer-Lemeshow test, calibration curve, decision curve analysis, and 1,000 bootstraps. We calculated the optimal cutoff value, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the prediction model. RESULTS Of the 146 patients, 57 (39.0%) experienced complications. The nomogram included age, multiple ingestions, vomiting, abdominal pain, and abdominal tenderness. The AUC was 0.941, and the internally validated AUC was 0.930. The optimal cutoff value selected as a predictive value was 0.534, with a sensitivity of 82.5%, specificity of 93.3%, positive predictive value of 88.7%, negative predictive value of 89.3%, and accuracy of 89.0%. The Hosmer-Lemeshow test yielded a P value of 0.750. The calibration plot exhibited high consistency in prediction, and decision curve analysis showed excellent net benefits. DISCUSSION Our nomogram demonstrates excellent discrimination, calibration, and clinical utility and may thus help clinicians accurately assess the risk of complications from pediatric multiple magnet ingestion.
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Affiliation(s)
- Yizhen Luo
- Department of Radiology, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
| | - Xiongjian Cui
- Department of General Surgery, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
| | - Jianli Zhou
- Department of Gastroenterology, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
| | - Yijiang Zhuang
- Department of Radiology, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
| | - Chenrui Zheng
- Department of Radiology, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
| | - Qiru Su
- Department of Clinical Research, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
| | - Yungen Gan
- Department of Radiology, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
| | - Zhiyong Li
- Department of Radiology, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China
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Chen Y, Chen Q, Qian Y, Wang L, Chen S, Zhang S, Gao Z. Individualized Treatment of Multiple Magnetic Foreign Body Ingestion in Children. J Laparoendosc Adv Surg Tech A 2025; 35:94-100. [PMID: 39761080 DOI: 10.1089/lap.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2025] Open
Abstract
Background: The incidence of multiple magnetic foreign body (MMFB) ingestion in children is rising, which poses a serious risk for gastrointestinal tract injury. In the current study, the clinical characteristics were analyzed to enhance awareness among parents and caregivers, treatment experiences were summarized and discussed, and optimal treatment plans were identified. Methods: A retrospective analysis was performed on 130 pediatric patients with MMFB ingestion at the Children's Hospital Affiliated with Zhejiang University School of Medicine, between June 2016 and June 2023. The clinical data, treatment details, and patient prognosis were systematically collected. Results: Forty-one patients were managed conservatively, while 89 patients underwent open surgery. Among the 44 patients who were treated with laparoscopic surgery, conversion to laparotomy was necessary in 28. The risk of gastrointestinal perforation was higher in symptomatic children than in asymptomatic children (chi-square value: 37.156; P < .001). Perforations were mainly observed in the small intestine. The median length of hospital stay was 10 days in the cohort of 16 children who underwent laparoscopic surgery successfully, which differed from the group of 28 children who were converted to a laparotomy (10 days [interquartile range, or IQR: 9-12.75 days] versus 12 days [IQR: 10-15.75 days]; P < .05). Conclusions: The ingestion of MMFBs in children can lead to severe injuries, underscoring the importance of early detection and treatment. Tailored clinical management strategies should be implemented based on individual conditions, while prompt and effective interventions can minimize harm. Therefore, we propose a comprehensive framework for individualized treatment processes.
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Affiliation(s)
- Yi Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qingjiang Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yunzhong Qian
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Linyan Wang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Sai Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuhao Zhang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhigang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Hayward RK, Saxena AK. Surgical management of pediatric multiple magnet ingestions in the past two decades of minimal access surgery- systematic review of operative approaches. Updates Surg 2024; 76:1203-1211. [PMID: 38310610 DOI: 10.1007/s13304-023-01750-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Multiple magnet ingestion is increasingly reported in paediatrics and can cause significant morbidity. Various surgical approaches exist, though minimal literature compares outcomes between techniques. This review evaluates laparoscopic, laparoscopic-assisted, and open surgery with regard to outcomes. METHOD Systematic review across MEDLINE, Embase, Scopus, and Web of Science identified reports of paediatric multiple magnet ingestion managed surgically between 2002 and 2022. RESULTS Ninety-nine studies were included, reporting data from 136 cases. Of these, 82 (60%) underwent laparotomy, 43 (32%) laparoscopic surgery, and 11 (8%) laparoscopic-assisted procedures. Sixteen laparoscopic cases were converted to open, often due to intraoperative findings including necrosis/perforation, or grossly dilated bowel. Bowel perforation occurred in 108 (79%); 47 (35%) required bowel resection, and 3 had temporary stoma formation. Postoperative recovery was uneventful in 118 (86%). Complications were reported following 15 (18%) open and 3 (7%) laparoscopic surgeries. No complications occurred following laparoscopic-assisted surgery. All post-laparoscopic complications were Clavien-Dindo (CD) Grade I. Following open surgery, 5 complications were CD grade I, 6 were CD grade II, and 4 were CD grade IIIb, requiring re-laparotomy. Median length of stay for open and laparoscopic-assisted procedures was 7 days, and for laparoscopic was 5 days (p < 0.001). CONCLUSION Surgical management of multiple magnet ingestion often achieved uncomplicated recovery and no long-term sequelae. Whilst open laparotomy was the more common approach, laparoscopic surgery was associated with reduced length of stay and postoperative complications. Therefore, in experienced hands, laparoscopic surgery should be considered first-line, with the possibility of conversion to open if required.
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Affiliation(s)
- Romilly K Hayward
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK
| | - Amulya K Saxena
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.
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Schaffer O, Kenoshi A, Zmora O. Early colonic-preparation and salvage laparoscopic appendectomy (ECSLA)- innovative protocol for the management of magnets ingestion. Int J Emerg Med 2024; 17:88. [PMID: 39009975 PMCID: PMC11247818 DOI: 10.1186/s12245-024-00678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Ingestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity. METHODS The Early Colonic-preparation and Salvage Laparoscopic Appendectomy (ECSLA) protocol includes initiating colonoscopy preparation upon admission in asymptomatic patients if magnets are not amenable to removal by gastroscopy, and laparoscopic magnets retrieval via appendectomy if surgery is eventually needed. The protocol was initiated in May 2023. A retrospective study of all cases of ingested magnets in children in our institution during July 2020 - January 2024 was conducted to retrieve and analyze demographic, clinical, imaging, management, and outcome data. RESULTS During the 3.5-year study period, 13 cases of ingested multiple magnets were treated, including 7 cases since initiation of ECLSA protocol, with no complications. Since initiation of ECSLA protocol, Early colonic preparation resulted in spontaneous passage of magnets (two cases) and successful colonocsopic removal (three cases), with two cases in which magnets were retrieved via gastroscopy upon admission, and no patients needing surgical intervention. Length of stay (LOS) was short (1-3 days). CONCLUSIONS The ECSLA protocol is a promising tool for preventing surgical intervention and complications and for possibly shortening LOS in children who have ingested multiple magnets.
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Affiliation(s)
- Ortal Schaffer
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Kenoshi
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Zmora
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Ardila S, Woodley L, Ulloa E, Fernandez J, Bornstein J, Seims A. Utilization of Single-Incision Laparoscopy in the Management of Ingested Magnets. J Laparoendosc Adv Surg Tech A 2024; 34:530-534. [PMID: 38016150 DOI: 10.1089/lap.2023.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Background: A ban on neodymium magnets was lifted by the U.S. Consumer Product Safety Commission in 2016. Pediatric gastroenterologists and surgeons were increasingly tasked with removing these problematic objects. The purpose of this study was to assess the utility of single-incision laparoscopic surgery (SILS) in the management of ingested magnets. Patients and Methods: This is a single-center, retrospective assessment of surgical interventions for ingested magnets. International Classification of Disease, 10th revision codes were used to identify 349 patients ≤21 years of age evaluated for foreign body ingestion over a 4.5-year period. A medical record review helped isolate 29 (8.3%) magnet ingestions, 9 requiring surgical intervention. RedCap was used for analysis. Results: Of 9 surgical patients, 7 underwent SILS intervention by 1 surgeon. Another surgeon performed an open operation, whereas a third performed a multiport operation. Of the 7 SILS cases, 3 were completed without conversion to open. In one of these cases, bowel resection with primary anastomosis was performed. For SILS cases, average operating room time was 109 minutes (38-170 minutes), time to enteral feeds was 23 hours (0.28-79.2 hours), and hospital length of stay (LOS) was 3.8 days (1.96-6.68 days). Thirty-day readmission for SILS was 14.3%. No other complications were observed. Conclusions: SILS has been safely utilized for magnet retrieval. It offers an ability to identify the affected intestinal segment and an opportunity to intervene extracorporeally through an uncapped port. In addition, knowing where matted bowel is located can direct a limited incision during conversion to laparotomy. This may confer benefits of decreased pain, shortened time to enteral feeds, and decreased hospital LOS.
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Affiliation(s)
- Sara Ardila
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Lucille Woodley
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Emily Ulloa
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Jenelle Fernandez
- Department of Gastroenterology, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Jeffery Bornstein
- Department of Gastroenterology, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Aaron Seims
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
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Quitadamo P, Gragnaniello P, Isoldi S, Bucci C, Esposito F, Russo S, Grella MG, Caldore M. Magnetic foreign body ingestion in pediatric age. Dig Liver Dis 2024; 56:1002-1006. [PMID: 37985250 DOI: 10.1016/j.dld.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
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.
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Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Piergiorgio Gragnaniello
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Cristina Bucci
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Francesco Esposito
- Department of Emergency Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Silvana Russo
- Pediatric Surgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | | | - Mariano Caldore
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
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Gizewska-Kacprzak K, Nicieja K, Gajek B, Babiak-Choroszczak L. Removal of Multiple Ingested Magnets Through Laparoscopic Appendectomy in an Adolescent: A Report of Two Cases. Cureus 2024; 16:e58825. [PMID: 38654962 PMCID: PMC11037925 DOI: 10.7759/cureus.58825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 04/26/2024] Open
Abstract
Magnet ingestion can lead to serious health issues, including inflammation, gastrointestinal tract perforation, and even life-threatening complications. Despite legislative actions and numerous reports on the dangers of magnet ingestion in children, it remains a significant public health concern. Physicians must remain vigilant in cases of acute abdomen with ambiguous symptoms or unclear history in young patients. Prompt diagnosis and surgical intervention in case of multiple magnet swallowing are crucial to prevent complications. We present two cases of successful removal of ingested magnetic spheres through laparoscopic appendectomy in adolescents. This study aimed to highlight the technical aspects of the procedure to share the benefits of minimally invasive surgery (MIS) in the management of magnetic foreign bodies (FBs) located in the appendix or cecum.
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Affiliation(s)
- Kaja Gizewska-Kacprzak
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Karol Nicieja
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Bartosz Gajek
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Lidia Babiak-Choroszczak
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
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Grandjean-Blanchet C, Eltorki M, Strickland M, Kang A, Wen A, Rosenfield D. Evaluating Multiple Magnet Ingestion at 2 Large Canadian Pediatric Hospitals After Reintroduction to the US Marketplace. Pediatr Emerg Care 2024; 40:214-217. [PMID: 37083691 DOI: 10.1097/pec.0000000000002948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVES To determine the trend in incidence of pediatric magnet ingestions at 2 large Canadian tertiary pediatric hospitals after reintroduction of magnets to the US marketplace and to evaluate morbidity and mortality related to these ingestions. METHODS This was a retrospective study performed in 2 tertiary care pediatric hospitals between 2004 and 2019. We reviewed the charts of all children who presented with a foreign body ingestion and included those with reported magnet ingestion. We characterized all events and compared the incidence rate before and after the US ban was overturned in 2016. Descriptive statistics were used to summarize our results. Incidence rate ratio was calculated using the total number of magnet ingestion cases and total emergency department visits normalized to 100,000 emergency department visits/year. RESULTS We screened a total of 6586 ingestions and identified 192 patients with magnet ingestions. The period after the mandatory recall was compared with the period after the US ban revocation yielding an incidence rate ratio of 0.76 for all magnet ingestions ( P = 0.15) and 0.73 ( P = 0.34) for multiple magnet ingestions. There was, however, a graphical upward trend that immediately followed the US ban revocation. Sixty-nine patients (36%) were admitted to the hospital and 45 (23%) required a procedure to remove the magnet ingested. No deaths occurred. CONCLUSIONS Our findings suggest that the overturning of the US ban did not lead to a significant increase in the incidence of rare earth magnet ingestion in 2 large tertiary pediatric hospitals in Canada despite noting a trend upwards.
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Affiliation(s)
| | - Mohamed Eltorki
- McMaster Children's Hospital, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Matt Strickland
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Aaron Wen
- McMaster Children's Hospital, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Alansari AN, Baykuziyev T, Soyer T, Akıncı SM, Al Ali KK, Aljneibi A, Alyasi NH, Afzal M, Ksia A. Magnet ingestion in growing children: a multi-center observational study on single and multiple magnet incidents. Sci Rep 2024; 14:4575. [PMID: 38403623 PMCID: PMC10894856 DOI: 10.1038/s41598-024-55127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024] Open
Abstract
Over the past 15 years, there has been a noticeable uptick in incidents involving children ingesting multiple magnetic foreign bodies which can cause injuries and gastrointestinal complications including death. The current study aimed to identify the prevalence, clinical presentation, and management of single or multiple magnet ingestions. A retrospective multi-central cross-sectional study was conducted to include all pediatric patients < 18 years presented to the emergency department with ingestion of single or multiple magnets and admitted across hospitals in Qatar, UAE, KSA, Tunisia, and Turkey between January 2011 and December 2021. Demographics, symptoms, management, and outcomes were analyzed. There were 189 magnet ingestions, of which 88 (46.6%) were multiple magnet ingestions. Most patients (55.6%) were male, and the median age was 3.9 (IQR 2-7) years. An abdominal X-ray was obtained in all cases. 119 (62%) patients were conservatively treated, 53 (28%) required surgical intervention and 17 (8.9%) underwent gastroscopy. None of the patients with single magnet ingestions experienced morbidity or severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations, perforations (44.3%), severe intestinal necrosis (19.3%), peritonitis (13.6%), severe abdominal infection (10.2%), and septic shock (4.5%). The rate of surgical intervention (59.1% vs. 1.0%) and gastroscopy (15.9% vs. 3.0%) was significantly higher in the multiple ingestion group compared to the single magnet ingestion group. No deaths were identified. A high risk of serious complications, including the need for surgery to remove the magnets and substantial morbidity may result from swallowing more than one magnet. Magnet safety requirements, public education, and improved legislation are urgently required.
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Affiliation(s)
- Amani N Alansari
- Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar.
| | - Temur Baykuziyev
- Department of Anesthesiology, ICU and Perioperative Medicine, Hamad General Hospital, Doha, Qatar
| | - Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Servet Melike Akıncı
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Khalid Khalfan Al Ali
- Department of Pediatric Surgery, Al Qassimi Women and Children's Hospital, Sharjah, United Arab Emirates
| | - Adel Aljneibi
- Department of Pediatric Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Nafea Hussain Alyasi
- Department of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Muhammad Afzal
- Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Kingdom of Saudi Arabia
| | - Amine Ksia
- Department of Pediatric Surgery, Faculty of Medicine, Fattouma Bourguiba Hospital, Monastir, Tunisia
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11
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Li XL, Zhang QM, Lu SY, Liu TT, Li SL, Chen L, Xie FN, Wang L, Zhang CH, Wang DY, Huang LM. Accidental ingestion of multiple magnetic beads by children and their impact on the gastrointestinal tract: a single-center study. BMC Pediatr 2024; 24:5. [PMID: 38172693 PMCID: PMC10763124 DOI: 10.1186/s12887-023-04425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE In this study, we aimed to enhance the treatment protocols and help understand the harm caused by the accidental ingestion of magnetic beads by children. METHODS Data were collected from 72 children with multiple gastrointestinal perforations or gastrointestinal obstructions. The 72 pediatric patients were divided into a perforation and a non-perforation group. The data collected for the analysis included the gender, age, medical history, place of residence (rural or urban), and symptoms along with the educational background of the caregiver, the location and quantity of any foreign bodies discovered during the procedure, whether perforation was confirmed during the procedure, and the number of times magnetic beads had been accidentally ingested. RESULTS The accuracy rate of preoperative gastrointestinal perforation diagnosis via ultrasound was 71%, while that of the upright abdominal X-ray method was only 46%. In terms of symptoms, the risk of perforation was 13.844 and 12.703 times greater in pediatric patients who experienced vomiting and abdominal pain with vomiting and abdominal distension, respectively, compared to patients in an asymptomatic state. There were no statistical differences between the perforation and the non-perforation groups in terms of age, gender, medical history, and the number of magnetic beads ingested (P > 0.05); however, there were statistical differences in terms of white blood cell count (P = 0.048) and c-reactive protein levels (P = 0.033). A total of 56% of cases underwent a laparotomy along with perforation repair and 19% underwent gastroscopy along with laparotomy. All pediatric patients recovered without complications following surgery. CONCLUSION Abdominal ultrasonography and/or upright abdominal X-ray analyses should be carried out as soon as possible in case of suspicion of accidental ingestion of magnetic beads by children. In most cases, immediate surgical intervention is required. Given the serious consequences of ingesting this type of foreign body, it is essential to inform parents and/or caregivers about the importance of preventing young children from using such products.
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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, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Qin-Ming Zhang
- Department of Surgery, Beijing United Family Hospital, 100015, Beijing, China
| | - Shou-Yan Lu
- Department of Surgery, Beijing Aiyuhua Women's and Children's Hospital, 100176, Beijing, China
| | - Ting-Ting Liu
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Shuan-Ling Li
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Long Chen
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Fang-Nan Xie
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Li Wang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Chuang-Hui Zhang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Da-Yong Wang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China.
| | - Liu-Ming Huang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China.
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12
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Ignatiev VV, Muraviev AV, Garapov TA, Tishukov MY. [Magnetic foreign bodies of the gastrointestinal tract in pediatric practice]. Khirurgiia (Mosk) 2024:29-37. [PMID: 38477241 DOI: 10.17116/hirurgia202403129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To analyze the pediatric patients with multiple magnetic foreign bodies of the gastrointestinal tract undergoing surgical intervention; to present the treatment and diagnostic algorithm in pediatric practice; to compare surgical interventions for these lesions and determine the most optimal one. MATERIAL AND METHODS A retrospective single-center study included 9 patients diagnosed with multiple magnetic foreign bodies of the gastrointestinal tract. Exclusion criteria: outpatient cases and endoscopic removal of magnetic foreign bodies. All patients underwent laparoscopy and/or laparotomy. We analyzed postoperative data and determined the preferable approach. RESULTS All patients were discharged without complications. Length of hospital-stay was shorter after laparoscopy (7 vs. 12 days). Patients after laparoscopy didn't need for intensive care while laparotomy required ICU stay for 4.5±2.2 days. Enteral feeding started after 1 and 3 days, respectively. CONCLUSION Laparoscopy is preferable for multiple magnetic foreign bodies of the gastrointestinal tract due to shorter hospital-stay, no need for ICU-stay, lower surgical trauma and earlier enteral feeding.
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Affiliation(s)
- V V Ignatiev
- Sevastopol City Hospital No. 5 - Center for Maternal and Child Health, Sevastopol, Russia
| | - A V Muraviev
- Sevastopol City Hospital No. 5 - Center for Maternal and Child Health, Sevastopol, Russia
| | - T A Garapov
- Sevastopol City Hospital No. 5 - Center for Maternal and Child Health, Sevastopol, Russia
- Pirogov Sevastopol City Hospital No. 1, Sevastopol, Russia
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13
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Quezada H, Levine AE, Dellinger M, Rice-Townsend S, Zheng HB. Esophagogastric Fistula: The Consequence of High-Powered Magnets Ingestion. JPGN REPORTS 2023; 4:e385. [PMID: 38034440 PMCID: PMC10684210 DOI: 10.1097/pg9.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/02/2023] [Indexed: 12/02/2023]
Abstract
A 17-month-old female had an unwitnessed ingestion of 26 high-powered magnets, resulting in the creation of an esophagogastric fistula via the left crus of the diaphragm. This case highlights a rare injury to the stomach and esophagus caused by high-powered magnets requiring surgical intervention. Furthermore, this case report illustrates the risks that high-powered magnets pose to young children. Additionally, this case highlights the importance of maintaining a high level of suspicion for ingestion in young patients along with a multidisciplinary team to manage sequelae of injury.
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Affiliation(s)
- Hugo Quezada
- From the Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA
| | - Anne E. Levine
- From the Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Division of Gastroenterology and Hepatology, Seattle Children’s Hospital, Seattle, WA
| | - Matthew Dellinger
- Department of Surgery, University of Washington, Seattle, WA
- Division of Pediatric General Surgery, Seattle Children’s Hospital, Seattle, WA
| | - Samuel Rice-Townsend
- Department of Surgery, University of Washington, Seattle, WA
- Division of Pediatric General Surgery, Seattle Children’s Hospital, Seattle, WA
| | - Hengqi Betty Zheng
- From the Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Division of Gastroenterology and Hepatology, Seattle Children’s Hospital, Seattle, WA
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14
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Zhang RY, Cai P, Zhang TT, Zhu J, Chen JL, Zhao HW, Jiang YL, Wang Q, Zhu ML, Zhou XG, Xiang XL, Hu FL, Gu ZC, Zhu ZW. Clinical predictors of surgical intervention for gastrointestinal magnetic foreign bodies in children. BMC Pediatr 2023; 23:323. [PMID: 37355569 PMCID: PMC10290319 DOI: 10.1186/s12887-023-04125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND/AIMS To investigate the clinical situation, treatment methods, and clinical predictors of surgical intervention in children with magnetic foreign bodies in the digestive tract. MATERIALS AND METHODS From January 2019 to June 2022, we retrospectively analyzed the clinical data of 72 children who ingested magnetic foreign bodies inadvertently in our hospital, including their general information, admissions, clinical manifestations, and treatment methods, as well as pertinent literature and statistical data. Following software processing, univariate and multivariate logistic regression analyses were conducted to determine the independent risk factors of this study. RESULTS In this study, 16 patients (22.2%) were discharged smoothly following conservative treatment and 19 patients (26.4%) were cured by gastroscopy. The remaining 37 patients (51.4%) were underwent surgery, in which 26 cases developed gastrointestinal perforation. There were statistical differences between surgery group and non- surgery group in the days of eating by mistake, clinical manifestations (nausea and vomiting, intermittent abdominal pain, abdominal muscle tension) and movement trajectory by every 24-h radiograph (P < 0.01). Logistic regression analysis showed that intermittent abdominal pain and abdominal muscle tension were independent risk factors for surgical treatment. CONCLUSION Magnetic foreign bodies seriously endanger children's health. This study offers a single-center basis for the choice of surgical opportunity for intestinal obstruction or perforation caused by magnetic foreign bodies. Clinicians need immediate surgical intervention if the child shows symptoms of abdominal pain or abdominal tension.
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Affiliation(s)
- Rui Yun Zhang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Peng Cai
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Ting Ting Zhang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Jie Zhu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Jian Lei Chen
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Hao Wei Zhao
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Yu Liang Jiang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Qi Wang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Meng Lei Zhu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Xiao Gang Zhou
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Xian Lan Xiang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Fei Long Hu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Zhi Cheng Gu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Zhen Wei Zhu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China.
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15
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Nugud AA, Tzivinikos C, Assa A, Borrelli O, Broekaert I, Martin-de-Carpi J, Deganello Saccomani M, Dolinsek J, Homan M, Mas E, Miele E, Thomson M, Benninga MA. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. J Pediatr Gastroenterol Nutr 2023; 76:523-532. [PMID: 36947000 DOI: 10.1097/mpg.0000000000003702] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
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.
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Affiliation(s)
- A A Nugud
- From the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Christos Tzivinikos
- From the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Amit Assa
- The Juliet Keidan Institute of Pediatric Gastroenterology, Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Osvaldo Borrelli
- the Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Ilse Broekaert
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Jernej Dolinsek
- the Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
| | - M Homan
- the Faculty of Medicine, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Emmanuel Mas
- Service de Gastroentérologie, Hépatologie, Nutrition et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, and IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Erasmo Miele
- the Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Mike Thomson
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc A Benninga
- the Department of Paediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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16
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Sun RC, Mehl S, Rialon K, Vogel AM, Nuchtern J. Magnet Extraction Through Appendectomy Laparoscopically (METAL) technique as a novel method to manage ingested magnets in children. Am Surg 2023; 89:490-492. [PMID: 33283527 DOI: 10.1177/0003134820954849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raphael C Sun
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
| | - Steven Mehl
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
| | - Kristy Rialon
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
| | - Adam M Vogel
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
| | - Jed Nuchtern
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
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17
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Demiroren K. Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines. Pediatr Gastroenterol Hepatol Nutr 2023; 26:1-14. [PMID: 36816435 PMCID: PMC9911172 DOI: 10.5223/pghn.2023.26.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/09/2022] [Accepted: 08/30/2022] [Indexed: 01/15/2023] Open
Abstract
Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.
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Affiliation(s)
- Kaan Demiroren
- Department of Pediatric Gastroenterology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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18
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Birkhold M, Habib JR, Kang J, Diaz-Calderon L, Lumpkins K, Strauch E. Magnetic Appendix: An Uncommon Indication for Appendectomy. Cureus 2022; 14:e31096. [DOI: 10.7759/cureus.31096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
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19
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Seguier-Lipszyc E, Samuk I, Almog A, Silbermintz A, Kravarusic D. Multiple magnet ingestion in children: A problem on the rise. J Paediatr Child Health 2022; 58:1824-1828. [PMID: 35841278 DOI: 10.1111/jpc.16117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/12/2022] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
Abstract
AIM Ingestion of multiple magnets is increasing these last 15 years in children. They have resulted in numerous reports of serious gastrointestinal complications such as bowel obstruction, ischaemia, necrosis, perforation and fistula formation and even led to death. The increasing number of world-wide reports of complications secondary to magnet ingestion and a frequently delayed diagnosis point to a lack of awareness about these risks among medical care-givers in our country and parents in general. METHODS We reviewed retrospectively all cases of multiple magnet ingestion that required a gastro-intestinal or surgical procedure for removal from 2009 to 2020. RESULTS Five children underwent gastroscopy removal and three colonoscopy removal of the magnets. Five patients required surgical (laparotomy or laparoscopy) removal of multiple magnets with intestinal perforations. CONCLUSIONS We propose an updated management algorithm for multiple magnet ingestion to highlight awareness among primary physicians and parents of the presenting circumstances and symptoms as well as the potential complications associated with multiple magnet ingestion.
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Affiliation(s)
- Emmanuelle Seguier-Lipszyc
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel.,Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Samuk
- Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Anastasia Almog
- Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ari Silbermintz
- Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Dragan Kravarusic
- Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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20
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Abstract
OBJECTIVES To review the clinical management and outcomes of magnet ingestions at a large tertiary children's hospital. To determine the association of frequency of high-powered magnet ingestion with the regulation of these magnets. METHODS Children <18 years who presented to the emergency room and were admitted to the Children's Hospital of Philadelphia for ingestion of single or multiple magnets from January 2008 to December 2020 were included. Demographics, symptoms, management, and outcomes were analyzed. The frequency of magnet ingestion was compared over 3 eras: (1) pre-ban (2008-2012), (2) intra-ban (2013-2016), and (3) post-ban (2017-2020). RESULTS There were 167 magnet ingestions, including 99 with multiple magnets. Most patients (59%) were male and median age was 6 (interquartile range, 3-9) years. Most single magnet ingestions (86%) were discharged with outpatient monitoring, and none experienced severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations (68%), endoscopic procedures (48%), surgical procedures (14%), and severe outcomes (12%). Most patients (75%) were asymptomatic, however, there was a higher risk of surgery and severe complications based on the presence of symptoms ( P = 0.003). The rate of surgical intervention was higher with ≥3 magnets (31.7%) compared to 2 magnets (2.4%) ( P < 0.003). Additionally, we found an 160% increase in children with magnet ingestions in the post-ban period ( P = 0.021). CONCLUSIONS Multiple magnet ingestion is associated with high morbidity and rate of severe outcomes. There is a relationship between public policy of magnet sale and frequency of magnet ingestion.
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21
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Holtestaul T, Franko J, Escobar MA, Barlow M. Pediatric Ingestions. Surg Clin North Am 2022; 102:779-795. [DOI: 10.1016/j.suc.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Maravilla V, Mentessidou A, Malakounides G. Multiple Ball Magnet Ingestion With Sandwiching of the Uvula. J Emerg Med 2022; 63:306-308. [PMID: 35945117 DOI: 10.1016/j.jemermed.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/13/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Veniza Maravilla
- Department of Pediatric Surgery, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - Anastasia Mentessidou
- Department of Pediatric Surgery, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - Georgina Malakounides
- Department of Pediatric Surgery, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
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23
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Jin Y, Gao Z, Zhang Y, Cai D, Hu D, Zhang S, Mao J. Management of multiple magnetic foreign body ingestion in pediatric patients. BMC Pediatr 2022; 22:448. [PMID: 35879696 PMCID: PMC9316800 DOI: 10.1186/s12887-022-03501-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background Multiple magnetic foreign body ingestion in children is increasingly common and can cause serious injury. The present study aimed to analyze the clinical features of such cases and summarize treatment experiences. Methods A retrospective survey of 91 patients in the Children’s Hospital, Zhejiang University School of Medicine with magnetic foreign body ingestion from October 2018 to October 2021 was performed, the data were collected including the clinical information of the patients, treatment details, and prognosis. Results Twenty-two (24.2%) patients were conservatively treated, with the foreign bodies discharged through the anus, 31 (34.1%) underwent laparoscopic surgery, including 18 cases converting from laparoscopic surgery to laparotomy, and 38 (41.8%) underwent laparotomy. In 13 (14.3%) patients, the foreign bodies were partially removed by gastroscope. The remaining foreign bodies were removed by laparoscopy in six patients, including three cases converting from laparoscopy to laparotomy, by laparotomy in four patients, and by conservative treatment in three patients. Conclusions Multiple magnetic foreign body ingestion can cause significant harm to patients and different clinical techniques must be used for patients in different situations to reduce the harm to children.
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Affiliation(s)
- Yi Jin
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Zhigang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Yuebin Zhang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Duote Cai
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Di Hu
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Shuhao Zhang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China
| | - Jianhua Mao
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310051, Zhejiang Province, China.
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24
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Ding G, Liu H, Zhou P, Niu Q, Wang W, Feng Z, Zhang S, Zhang Z, Geng L, Bu Z, Fu T. Pediatric Multiple High-Powered Magnetic Buckyballs Ingestion—Experience From Six Tertiary Medical Centers. Front Public Health 2022; 10:892756. [PMID: 35784204 PMCID: PMC9240617 DOI: 10.3389/fpubh.2022.892756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Guojian Ding
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Hongzhen Liu
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Peng Zhou
- Department of Pediatric Surgery, Zibo Maternal and Child Health Care Hospital, Zibo, China
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Wei Wang
- Department of Pediatric Surgery, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Zhiqiang Feng
- Department of Pediatric Surgery, Taian Maternity and Child Health Hospital, Taian, China
| | - Shisong Zhang
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Zhengmao Zhang
- Department of Pediatric Surgery, Zibo Maternal and Child Health Care Hospital, Zibo, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
- *Correspondence: Lei Geng
| | - Zhaoyun Bu
- Department of Pediatric Surgery, People's Hospital of Rizhao, Rizhao, China
- Zhaoyun Bu
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
- Tingliang Fu
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25
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Encisco EM, Gerardo RG, Ponsky TA. High-powered magnets still require high-powered vigilance. J Pediatr Surg 2022; 57:949. [PMID: 35074180 DOI: 10.1016/j.jpedsurg.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ellen M Encisco
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA.
| | - Rodrigo G Gerardo
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Todd A Ponsky
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA
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26
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Chavan R, Bachkaniwala V, Tadkalkar V, Gandhi C, Rajput S. Endoscopic management of magnet ingestion and its adverse events in children. VideoGIE 2022; 7:302-307. [PMID: 36034063 PMCID: PMC9414231 DOI: 10.1016/j.vgie.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and Aims Magnet ingestion has recently increased among children. Multiple magnets can lead to serious adverse events owing to pressure necrosis of trapped bowel wall; therefore, urgent removal of the magnet is recommended. However, awareness of magnet ingestion and adverse events associated with it are lacking among the general population and some healthcare professionals. Herein, we demonstrate the adverse events associated with prolonged retention of ingested magnets and endoscopic management of ingested magnets in children. Methods We present a case series of 3 patients with magnet ingestion. Foreign body ingestion was confirmed on fluoroscopy. After fluoroscopy, all children underwent EGD under propofol sedation in a left lateral position. A Roth net was used to remove magnets. Results Three patients (median age 5 years), each with ingestion of 2 magnets of different shapes and sizes and with variable periods of ingestion, underwent EGD. In 2 patients, both magnets were Successfully removed. In 1 patient, 1 magnet could not be removed because it became dislodged deep in the jejunum. All 3 patients had developed magnet-related fistula (gastroduodenal: 1 patient; duodenojejunal: 2 patients). Patients with duodenojejunal fistula were managed conservatively. There was mild self-limited bleeding during magnet removal in 1 patient. There were no major adverse events related to endoscopic removal. Conclusions Endoscopic removal of magnets is feasible and safe in children. Few patients with fistulas can be managed conservatively. There is an unmet need to increase societal awareness of magnet ingestions and adverse events associated with it.
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Value of intestinal ultrasound in pediatric magnet ingestion: a case report. J Ultrasound 2022; 25:861-864. [PMID: 35275387 PMCID: PMC8914445 DOI: 10.1007/s40477-021-00631-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/06/2021] [Indexed: 11/03/2022] Open
Abstract
Ingestion of magnetic foreign bodies in pediatric settings has become more common in the last years due to the marketing of various toys containing small magnetic parts. Most magnets, especially if a single element is ingested, usually pass through the gastrointestinal tract without complications. However, ingestion of multiple magnets or magnets and small metallic components may require a prompt intervention due to the risk of attraction across bowel layers, leading to pressure necrosis, perforation, and even death. Routinely, serial radiological evaluations are needed to follow the progression of magnets through the intestine, while the role of small bowel ultrasound is regarded as marginal. Here we report a case of a 5-years old boy who ingested 8 magnets and in which small bowel ultrasound was pivotal for the correct assessment of magnets location to correct address the surgical approach.
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Middelberg LK, Leonard JC, Shi J, Aranda A, Brown JC, Cochran CL, Eastep K, Gonzalez R, Haasz M, Herskovitz S, Hoffmann JA, Koral A, Lamoshi A, Levitte S, Lo YHJ, Montminy T, Novak I, Ng K, Novotny NM, Parrado RH, Ruan W, Shapiro J, Sinclair EM, Stewart AM, Talathi S, Tavarez MM, Townsend P, Zaytsev J, Rudolph B. High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study. Pediatrics 2022; 149:184737. [PMID: 35112127 DOI: 10.1542/peds.2021-054543] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Leah K Middelberg
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie C Leonard
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Junxin Shi
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Arturo Aranda
- Division of Pediatric Surgery, Dayton Children's Hospital, Dayton, Ohio
| | - Julie C Brown
- Seattle Children's Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Christina L Cochran
- Department of Pediatrics, Division of Emergency Medicine, Children's of Alabama, University of Alabama at Birmingham College of Medicine, Birmingham, Alabama
| | - Kasi Eastep
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Norton Children's Hospital affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Maya Haasz
- Department of APediatrics, Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Scott Herskovitz
- Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, San Diego, California
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexander Koral
- Department of Pediatrics, Section of Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Abdulraouf Lamoshi
- Division of Pediatric Surgery, Cohen Children's Medical Center; Northwell Health, Queens, New York
| | - Steven Levitte
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Yu Hsiang J Lo
- Department of Emergency Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Taylor Montminy
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Inna Novak
- Children's Hospital at Montefiore, Albert Einstein College of Medicine; Bronx, New York
| | - Kenneth Ng
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan M Novotny
- Beaumont Children's, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Raphael H Parrado
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, South Carolina
| | - Wenly Ruan
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Joseph Shapiro
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Elizabeth M Sinclair
- Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Healthcare of Atlanta, Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia
| | - Amanda M Stewart
- Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Saurabh Talathi
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Oklahoma Children's Hospital, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Melissa M Tavarez
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Peter Townsend
- Department of Pediatrics, Division of Gastroenterology, Connecticut Children's Hospital, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Julia Zaytsev
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Bryan Rudolph
- Children's Hospital at Montefiore, Albert Einstein College of Medicine; Bronx, New York
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Xin Y, Jia LQ, Dong YW, Wang Y, Hu YX, Wang XM. Application of high-frequency ultrasound in the diagnosis of gastrointestinal magnet ingestion in children. Front Pediatr 2022; 10:988596. [PMID: 36714638 PMCID: PMC9880474 DOI: 10.3389/fped.2022.988596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of magnet ingestion by children has recently increased in China. Magnet ingestion is associated with an extremely high risk of gastrointestinal damage because loops of bowel can become trapped and squeezed between multiple magnets in different locations. However, the lack of imaging sensitivity makes clinical decision-making difficult. OBJECTIVE This study was conducted to investigate the performance of ultrasound in diagnosing gastrointestinal magnet ingestion in children. METHODS From April 2017 to February 2021, all children with a history of magnet ingestion or a diagnosis of gastrointestinal magnet as shown by x-ray or ultrasound in our hospital were included as study candidates. Patients who were lost to follow-up or had known malformations of the gastrointestinal tract were excluded. Eligible patients were those with surgical or endoscopic confirmation of gastrointestinal magnet, those who passed the magnet out of the alimentary tract without assistance, and those with confirmed absence of the magnet on abdominal x-ray examination after 1 month of conservative treatment. All eligible patients' ultrasound and x-ray examination data were evaluated. The sensitivity, specificity, and area under the curve (AUC) of ultrasound was calculated for diagnosing magnet ingestion, locating the magnet (stomach, small intestine, or colon), and confirming the phenomenon of wall entrapment. RESULTS Of 112 patients, 107 had a magnetic foreign body and 5 did not. Magnets were correctly detected by ultrasound in 97 patients, with an observed sensitivity of 90.65% and specificity of 100%. Satisfactory sensitivity was obtained for ultrasound localization of gastric magnets (96.30%) and small intestinal magnets (100.00%), but sensitivity for ultrasound localization of colonic magnets was relatively poor (73.33%). The discrimination of wall entrapment by ultrasound was good (AUC = 0.93), with an observed sensitivity and specificity of 92.00% and 93.62%, respectively. CONCLUSIONS Ultrasound can be used to locate gastrointestinal magnets (in the stomach, small intestine, or colon) with good clinical efficacy in identifying wall entrapment.
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Affiliation(s)
- Yue Xin
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Qun Jia
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ya Wei Dong
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yan Xiu Hu
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiao Man Wang
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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30
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Al-Saied G, Alsamahy O, Ibrahim M, Al-Malki T, BenMalek R, Khemakhem R, AlNefaie Z, Hussain T, Shafik Y, Thabet R, Farhan G, Gamal A, Habib SA, Gamal A, Elghazeery M. Enteroenteric fistulae after ingestion of multiple magnets in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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31
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Elzeneini WM, Cusick E. Endoscopic retrieval of ingested magnets in children and role of magnetic retrievers. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00128-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
Various high-powered magnetic toy sets constitute a major hazard as the small magnets can be easily swallowed or aspirated by young children. Multiple ingested magnets or the ingestion of a magnet with another metallic object can pose a serious threat as this may lead to bowel perforation, fistulation, intestinal volvulus, bowel obstruction and death.
Main body
Retrieval of ingested magnets from the stomach is routinely performed endoscopically but can become a painstaking quest involving many tedious attempts to secure the magnet(s). Historically, pre-routine endoscopy, magnetic retrievers were used under fluoroscopic control for the removal of metallic objects in the stomach. With the advent of endoscopic retrieval instruments, they fell out of favour and are no longer readily available on the market. Despite this, conventional endoscopic instruments are likely to be less effective than endoscopic-assisted magnetic retrievers due to confounding weak bonds which form between the metal retrieval device and the magnet.
Preoperative testing, and selection of the retrieval instrument with the strongest coupling effect with a magnet, might be beneficial. A simple, endoscopic-assisted magnetic retriever created in theatre can allow for more effective, time-efficient and safe removal of ingested magnets under direct vision.
Conclusion
Urgent removal of multiple ingested magnets or a single ingested magnet coupled with another ingested metallic object should be highlighted. Stricter implementation of a widespread ban over loose magnetic toys is needed. Standardised protocols for the surgical management of ingested magnets should be available in every hospital.
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Oh RG, Lee CG, Park YN, Lee YM. Successful removal of two magnets in the small intestine by laparoscopy and colonoscopy: A case report. World J Clin Cases 2021; 9:8226-8231. [PMID: 34621885 PMCID: PMC8462221 DOI: 10.12998/wjcc.v9.i27.8226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ingestion of multiple magnets can cause serious gastrointestinal complications, such as obstruction, fistulae, and perforation. When multiple magnets traverse the stomach, coordination between pediatric gastroenterologists and pediatric surgeons is recommended, and ultimate management is required dependent on clinical concerns.
CASE SUMMARY A 5-year-old girl swallowed 2 small magnets that then remained in the right lower quadrant (RLQ) of the abdomen for 3 d; this required endoscopic and laparoscopic intervention. Abdominal X-ray and computed tomography revealed high-density objects in the RLQ area. Colonoscopy after proper bowel preparations on the third day of ingestion revealed no foreign body in the colonic area or the end of the ileum. The two magnets were removed via colonoscopy with laparoscopic intervention.
CONCLUSION It is important to establish effective coordination between pediatric gastroenterologists and pediatric surgeons when using a non-invasive procedure to remove magnets.
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Affiliation(s)
- Ryang Geun Oh
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Cheol Gu Lee
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - You Na Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
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33
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Huang YK, Hong SX, Tai IH, Hsieh KS. Clinical characteristics of magnetic foreign body misingestion in children. Sci Rep 2021; 11:18680. [PMID: 34548505 PMCID: PMC8455587 DOI: 10.1038/s41598-021-96595-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/20/2021] [Indexed: 01/08/2023] Open
Abstract
Magnetic foreign body misingestion (MFBM) is now occurring more frequently. It may cause remarkable mortality and morbidity in children. A retrospective analysis of the clinical data of children admitted to Xiamen Children’s Hospital between March 2017 and July 2020 due to accidental MFBM. A total of 14 children who had MFBM were collected, the proportion between urban and rural areas was 8:6, and the ratio of male to female was 6:1. The age ranged from 1.2 to 8.9 years (median 4.6 years). The number of magnetic foreign bodies ingested by mistake is 1 to 17 (average 6.5). Magnetic foreign objects are divided into magnets (3 cases) + magnetic beads (11 cases). About 40% (5/14) of this patient series showed no available misingestion history. Management includes: 4 cases of open surgery (including 1 case of laparoscopic transfer to operation), 3 cases of laparoscopic surgery, 2 cases of gastroscopy, 5 cases of conservative treatment of foreign bodies discharged through the anus. Of the 7 surgical cases, 6 cases presented with intestinal obstruction and intestinal perforation (at least 1 intestinal perforation and at most 5). Abdominal sonography has limitations in the detection of magnetic foreign bodies in the digestive tract. The proportion of laparoscopic surgery in the 7 surgical cases is nearly half. All surgical cases recovered smoothly after treatment. Our experience shows that MFBM is a big issue for the small children! The early symptoms of MFBM are often atypical especially among young children and MFBM may lead to severe adverse events. We proposed a management strategy for MFBM in children. We advise pediatricians/emergency physicians, parents/children’s guardians and society should raise the collaborated alertness of MFBM. Global awareness of risk prevention of magnetic material accidental ingestion cannot be overemphasized.
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Affiliation(s)
- Yu Kun Huang
- Department of Critical Care Medicine, Children's Hospital of Fudan University Xiamen Branch, Xiamen, 361006, Fujian, China
| | - Shao Xian Hong
- Department of Critical Care Medicine, Children's Hospital of Fudan University Xiamen Branch, Xiamen, 361006, Fujian, China
| | - I Hsin Tai
- Department of Pediatric Emergency & Cardiology, China Medical University Hospital, China Medical University, Taichung, 40447, Taiwan.,Department of Medicine, College of Medicine, China Medical University, Taichung, 40447, Taiwan
| | - Kai Sheng Hsieh
- Department of Pediatrics, Taipei Medical University-Shuang Ho Hospital, New Taipei City, 23561, Taiwan.
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34
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Broekaert IJ, Dübbers M, Hünseler C. Kleine Magnete mit großer Wirkung. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mostafa MS, Darwish AA. Magnet ingestion in children and its implications: tertiary centre experience. Pediatr Surg Int 2021; 37:937-944. [PMID: 33839906 DOI: 10.1007/s00383-021-04889-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Swallowing multiple magnets or a magnet and second metallic object can carry risks of intestinal obstruction, fistula and perforation because they can attach to each other with loop of bowel in between. An updated management plan and reviewing our experience are warranted because of increased incidence of magnets ingestion among children. METHODS All the patients who had a history of single, multiple magnet or single magnet and second metallic object ingestion in Bristol Royal Hospital for children during the period from January 2014 till November 2020 were included in our study. RESULTS A total of 46 patients were referred to our hospital with a history of magnet ingestion. The number of magnets ingested ranged between one and twenty one magnets. All patients had abdominal x-ray undertaken either Antero-posterior alone (AP) (n = 32) or both AP and lateral (n = 14). Surgical intervention was performed in 18 patients; Oesophago-gastro-duodenoscopy (n = 8), laparotomy/laparoscpy (n = 10) to retrieve the magnets or deal with the complications. CONCLUSIONS Magnets ingestion in children can be tricky when it comes to management. Complications can happen quite often and carry severe risks on children. An updated structured algorithm is proposed to manage children with magnet ingestion.
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Affiliation(s)
- Mohamed Saber Mostafa
- Paediatric Surgery Department, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, BS28BJ, UK.,Paediatric Surgery Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Ahmed A Darwish
- Paediatric Surgery Department, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, BS28BJ, UK. .,Paediatric Surgery Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt.
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Zheng Y, Zhang Z, Yan K, Guo H, Li M, Lian M, Liu Z. Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China. BMC Pediatr 2021; 21:179. [PMID: 33865355 PMCID: PMC8052718 DOI: 10.1186/s12887-021-02642-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 04/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. METHODS This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. RESULTS A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including 5(9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%)cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the time of the surgical group from ingestion to arriving at the hospital was longer([80(5-336) vs 26(2-216)]hours, p < 0.001) while there was no significant difference in the mean age or the number of magnets swallowed. CONCLUSIONS Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 h, even in asymptomatic patients.
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Affiliation(s)
- Yucan Zheng
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhihua Zhang
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Kunlong Yan
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Hongmei Guo
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Mei Li
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Min Lian
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| | - Zhifeng Liu
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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Zhang S, Zhang L, Chen Q, Zhang Y, Cai D, Luo W, Chen K, Pan T, Gao Z. Management of magnetic foreign body ingestion in children. Medicine (Baltimore) 2021; 100:e24055. [PMID: 33466161 PMCID: PMC7808496 DOI: 10.1097/md.0000000000024055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
Magnetic foreign bodies ingestion is a special cause for attending emergency department. Here, we aim to analyze the characteristics and treatments of children who ingested magnetic foreign bodies (Buckyballs). Data were collected from children who ingested Buckyballs between February 2017 and October 2019. A retrospective analysis was performed to summarize the experiences of conservative treatment, gastroscopy and surgery when dealing with Buckyballs ingestion.A total of 49 patients with buckyballs ingestion were identified, of whom 11 underwent conservative treatments, 6 underwent gastroscopy, and 32 underwent surgery. Among such individuals, eight patients (72.7%) had a successful conservative treatment (number of Buckyballs [NB]: 3.5[IQR: 2.0-4.0]); four patients (66.7%) had Buckyballs successfully removed by gastroscopy (NB: 3.5[IQR: 3.0-5.5]); 16 asymptomatic (50%) patients (NB: 4.0[IQR: 3.0-8.0]) and 16 symptomatic (50%) patients (NB: 8.5 [IQR: 6.25-11.75]) received emergency surgery. Compared to patients who received conservative treatment, the number of ingested Buckyballs was significantly higher in patients who received surgery or gastroscopy (7.0 [IQR: 3.0-10.75] vs 3.5 [IQR: 2.0-4.0], P < .05). The risk of intestinal perforation was significantly higher in symptomatic patients (P < .05) compared to asymptomatic patients.Gastroscopy is recommended when Buckyballs are in the stomach or esophagus. In asymptomatic patients, conservative treatment can be considered for 4 to 6 days. Patients failing conservative treatment, or those who are symptomatic should undergo emergency surgery.
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38
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Multiple magnetic foreign bodies causing complex intestinal fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Hui KJ, Arasu VA, Vinson DR, Cotton DM. Neodymium Magnetic Bead Ingestion in a Toddler. Perm J 2020; 24:19.165. [PMID: 33196425 DOI: 10.7812/tpp/19.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Kenneth J Hui
- California Northstate University College of Medicine, Elk Grove, California
| | - Vignesh A Arasu
- The Permanente Medical Group, Oakland, California.,Department of Radiology, Kaiser Permanente Vallejo Medical Center, Vallejo, California
| | - David R Vinson
- The Permanente Medical Group, Oakland, California.,Kaiser Permanente Division of Research, Oakland, California.,Department of Emergency Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, California
| | - Dale M Cotton
- The Permanente Medical Group, Oakland, California.,Department of Emergency Medicine, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
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40
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Lorenze A, Downey S, Costello LM, Menchini CB. Gastric Mucosa Fistula Secondary to Magnet Ingestion. JPGN REPORTS 2020; 1:e015. [PMID: 37206608 PMCID: PMC10191461 DOI: 10.1097/pg9.0000000000000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/22/2020] [Indexed: 05/21/2023]
Abstract
A 15-month-old female was incidentally found to have foreign bodies in the left upper quadrant on chest and abdominal imaging. She had no witnessed ingestion or gastrointestinal symptoms. Subsequent esophagogastroduodenoscopy showed 11 magnets, which formed a gastric mucosa fistula making endoscopic removal difficult. This case highlights the dangers of high-powered magnets and the unique challenges they can pose to endoscopists.
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Affiliation(s)
- Alyssa Lorenze
- From the Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Syndey Downey
- From the Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Lisa M. Costello
- From the Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
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41
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Mobile phone ingestion requiring endoscopic retrieval. Am J Emerg Med 2020; 42:265.e1-265.e2. [PMID: 33071077 DOI: 10.1016/j.ajem.2020.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022] Open
Abstract
A 24-year-old male was brought to our emergency with complaints of abdominal pain for two days. There was a history of foreign body ingestion five days earlier, details of which he refused to reveal. After investigation with abdominal X ray and ultrasound, the foreign body was detected to be a mobile phone containing a battery. Clinical evaluation revealed no signs of lithium toxicity due to battery leak. The patient underwent endoscopy for removal of the mobile phone. The case shows the importance of thorough investigation and prompt attempt at endoscopic removal in the event of ingestion of foreign bodies containing batteries.
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42
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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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43
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Multiple magnet ingestion: Ring-like configuration with multiple intestinal fistulae. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Meyer TJ, Grunz JP, Taeger J, Rak K, Hagen R, Hackenberg S, Völker J, Scherzad A. Systematic analysis of button batteries', euro coins', and disk magnets' radiographic characteristics and the implications for the differential diagnosis of round radiopaque foreign bodies in the esophagus. Int J Pediatr Otorhinolaryngol 2020; 132:109917. [PMID: 32032915 DOI: 10.1016/j.ijporl.2020.109917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Button battery (BB) ingestion can cause life-threatening complications such as esophageal perforation, and mediastinitis. Chest radiography is the method of choice to diagnose BB ingestion. Therefore, an adequate interpretation of X-ray imaging by physicians is mandatory. The study aimed to analyze relevant diagnostic aspects of BB X-ray imaging, and retrospective analysis of the imaging of radiopaque foreign bodies. METHODS All commercially available BBs and different foreign bodies such as euro coins (EC) and disk magnets (DM) were listed according to their sizes and compositions. Furthermore, an X-ray analysis of a test set of BBs, ECs and DMs was performed at angles of 0°, 45°, and 90°. Retrospective assessment of radiological characteristics was performed for patients with a round and radiopaque foreign body in the esophagus RESULTS: Only BBs with a diameter of at least 20 mm had a reliable positive double rim sign at scan angles of 90°, and 45°. The step-off effect was visible in all BBs regardless of the diameter. DMs and ECs presented a homogeneous X-ray weakening at all investigated scan angles. In the retrospective analysis all five cases of BB ingestion showed a double rim sign, all fifteen cases of coin ingestion a homogeneous X-ray weakening. A corrugated margin was detected for 10 cent, 20 cent and 50 cent coins. CONCLUSIONS BBs with a diameter of at least 20 mm showed, depending on the battery model, a more or less pronounced double rim sign and step-off effect in conventional X-ray imaging. However the double rim sign can be simulated by for example a pot magnet.
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Affiliation(s)
- Till Jasper Meyer
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Str. 6, Wuerzburg, D-97080, Germany.
| | - Johannes Taeger
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Stephan Hackenberg
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Johannes Völker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
| | - Agmal Scherzad
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, Wuerzburg, D-97080, Germany.
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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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Magnetic Apposition across the Epiglottis: Radiographic and Operative Correlation of a Rare Hypopharyngeal Foreign Body. Case Rep Radiol 2020; 2020:3245634. [PMID: 32089938 PMCID: PMC7021466 DOI: 10.1155/2020/3245634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/30/2019] [Indexed: 11/17/2022] Open
Abstract
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.
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Feng S, Peng H, Xie H, Bai Y, Yin J. Management of Sharp-Pointed Esophageal Foreign-Body Impaction With Rigid Endoscopy: A Retrospective Study of 130 Adult Patients. EAR, NOSE & THROAT JOURNAL 2020; 99:251-258. [PMID: 31996037 DOI: 10.1177/0145561319901033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To propose a management algorithm for adult patients with sharp-pointed esophageal foreign-body impaction (EFBI) who have rigid endoscopy (RE) indications and to conduct a retrospective analysis of their data. METHODS All adult patients who received RE at the Department of Otorhinolaryngology in Beijing Shijitan Hospital between January 2017 and May 2019 were enrolled. The demographics, clinical characteristics, and management data were collected and analyzed. RESULTS A total of 130 patients were identified, 56.9% were female with median age 60 years. More than half (56.9%) of patients had foreign-body (FB) ingestion on holidays. The most frequent FBs were jujube pits (66.9%) and bones (23.8%). There is a significant female predominance in ingestion of jujube pits (65.5%, P = .005). The most common symptoms were odynophagia (49.2%) and sore throat (47.7%). The majority (96.8%) of FB founded were lodged at upper esophagus. In all, 74 patients were categorized as having mild complications and 54 having significant complications. Time interval from ingestion to presentation longer than 15 hours was an independent risk factor for significant complications, while esophagogram with barium as a protective factor. CONCLUSIONS Long-time interval from ingestion to presentation will lead to high risk of significant complications. Computed tomography should be a prioritized imaging method for all patients suspected with EFBI, and multidisciplinary collaboration is recommended. Besides, mass education on eating habits is necessary.
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Affiliation(s)
- Shui Feng
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hong Peng
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hong Xie
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yunbo Bai
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Jinshu Yin
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
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Dotlacil V, Frybova B, Vyhnanek M, Zeman L, Rygl M. Removal of Ingested Magnetic Bodies via Laparoscopic Appendectomy. European J Pediatr Surg Rep 2020; 8:e68-e70. [PMID: 33101833 PMCID: PMC7577785 DOI: 10.1055/s-0040-1714669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 06/05/2020] [Indexed: 11/30/2022] Open
Abstract
Ingestion of a foreign body is a frequent diagnosis in the pediatric population. In a small percentage of cases, foreign bodies themselves are strong magnets, and swallowing of multiple magnetic bodies can lead to serious complications in the gastrointestinal tract. Two consecutive case reports of patients who swallowed two magnetic beads are presented. In both cases, the abdominal radiograph described two magnets in contact, one in the area of the left hypochondrium and one in the right hypogastrium. Attempts of endoscopic localization and removal were unsuccessful. Due to the failure of magnet progression, laparoscopic revision of the abdominal cavity was indicated in both patients on the 25th and 4th day after swallowing. Using the magnetic forces between the magnets and the laparoscopic instruments, the foreign bodies were localized in the appendix of the first patient and in the cecum of the other one. The magnets were extracted together with the removal of the appendix in both patients. This is one of the first articles describing the successful extraction of foreign magnetic bodies from the gastrointestinal tract via laparoscopic appendectomy.
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Affiliation(s)
- Vojtech Dotlacil
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Barbora Frybova
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Vyhnanek
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Lubos Zeman
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Michal Rygl
- Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Hu B, Ye LS. Endoscopic applications of magnets for the treatment of gastrointestinal diseases. World J Gastrointest Endosc 2019; 11:548-560. [PMID: 31839874 PMCID: PMC6885730 DOI: 10.4253/wjge.v11.i12.548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic treatment of gastrointestinal diseases has developed rapidly in recent years, due to its minimally invasive nature. One of the main contributing factors for this progress is the improvement of endoscopic instruments, which are essential for facilitating safe and effective endoscopic interventions. However, the slow learning curve required in the implementation of many advanced endoscopic procedures using standard devices is associated with a high risk of complications. Other routine procedures may also be complicated by unexpected difficulties. Based on the ferromagnetic properties of many objects, both internal and external magnetic devices have been developed and applied for multiple endoscopic interventions. The applications of magnets, mainly including compression, anchoring and traction, facilitate many difficult procedures and make it feasible to operate procedures that were previously impossible. Other novel endoscopic applications, such as magnetic nanoparticles, are also under development. In this article, we reviewed published studies of endoscopic applications of magnets for the treatment of gastrointestinal diseases such as precancerous lesions and cancer, obstruction, stricture, congenital and acquired malformations, motility disorders, and ingestion of foreign bodies. Since several endoscopic applications of magnets may also be relevant to surgery, we included them in this review.
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Affiliation(s)
- Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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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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