Toy magnet ingestion in children: revising the algorithm

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Abstract

The widespread popularity of magnetic toy sets has resulted in increased reports of magnet ingestion and subsequent complications. Traditional algorithms for ingested foreign bodies have advocated passage of these objects through the gastrointestinal tract spontaneously. In regard to magnet ingestion, the unique mechanism of pathogenesis, attraction of 2 or more magnets across multiple loops of bowel, has led to several cases of intestinal perforation caused by bowel wall erosion and necrosis between the magnets. Unfortunately, a misdiagnosis and misconception that a solitary magnet has been ingested may lead to a delay in diagnosis and subsequent severe and possibly preventable complications. We report a case in which a child presented having thought to have ingested a solitary magnetic toy from a magnet construction set. This resulted in the premature discharge from the hospital and the patient's subsequent return with an intraabdominal perforation resulting in an emergency laparotomy. The recent increase of case reports related to magnet ingestion has resulted in proposed treatment regimens for patients ingesting multiple magnets. We would also initiate the magnet algorithm if even presumably a single magnet was ingested. This would include close observation and early intervention, either with endoscopy or surgical exploration, which would theoretically prevent the more severe complications, reported in the literature.

Section snippets

Case

A 3-year-old boy presented to the emergency department with a 24-hour history of abdominal pain and nonbilious vomiting. At that time, he was not ill-appearing and was afebrile. An abdominal radiograph was obtained demonstrating multiple mildly distended loops of small bowel and a rod-like object that appeared intraluminal (Fig. 1).

His mother, at that time, immediately recognized the object as a magnetic stick from his magnetic toy construction set. He was subsequently admitted for observation

Discussion

The incidence of foreign body ingestion is more than 100,000 patients annually in the United States alone [20]. More than 80% of these occur in the pediatric population with 98% percent of these being accidental. Endoscopic retrieval is required in 10% to 20% of foreign bodies ingested owing to obstruction or failure of the object to pass through the esophagus, pylorus, or duodenal sweep. The vast majority of objects that reach the stomach will pass through the gastrointestinal tract

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