Elsevier

Journal of Pediatric Surgery

Volume 53, Issue 9, September 2018, Pages 1815-1819
Journal of Pediatric Surgery

Other Conditions
Magnet foreign body ingestion: rare occurrence but big consequences

https://doi.org/10.1016/j.jpedsurg.2017.08.013Get rights and content

Abstract

Purpose

To review the outcomes of magnet ingestions from two children's hospitals and develop a clinical management pathway.

Methods

Children < 18 years old who ingested a magnet were reviewed from 1/2011 to 6/2016 from two tertiary center children's hospitals. Demographics, symptoms, management and outcomes were analyzed.

Results

From 2011 to 2016, there were 89 magnet ingestions (50 from hospital 1 and 39 from hospital 2); 50 (56%) were males. Median age was 7.9 (4.0–12.0) years; 60 (67%) presented with multiple magnets or a magnet and a second metallic co-ingestion. Suspected locations found on imaging were: stomach (53%), small bowel (38%), colon (23%) and esophagus (3%). Only 35 patients (39%) presented with symptoms and the most common symptom was abdominal pain (33%). 42 (47%) patients underwent an intervention, in which 20 (23%) had an abdominal operation. For those undergoing abdominal surgery, an exact logistic regression model identified multiple magnets or a magnet and a second metallic object co-ingestion (OR 12.9; 95% CI, 2.4 – Infinity) and abdominal pain (OR 13.0; 95% CI, 3.2–67.8) as independent risk factors.

Conclusion

Magnets have a high risk of requiring surgical intervention for removal. Therefore, we developed a management algorithm for magnet ingestion.

Level of evidence

Level III.

Section snippets

Study design

Following approval by the Institutional Review Board (IRB) of Children's Mercy Hospital (IRB#16070546) and Texas Children's Hospital (IRB#H39198), medical records of all children less than 18-years-old with magnet ingestions were retrospectively reviewed from January 2011 to June 2016. Patients were identified based on International Classification of Disease Ninth Revision (ICD-9) diagnosis coding. Patients diagnosed with foreign body ingestion, which included mouth, esophagus and stomach

Patient characteristics

A total of 89 patients were found to have ingested a magnet (Hospital 1 = 50 and Hospital 2 = 39) (Table 1). The median age was 7.9 (4.0–12.0) years, and there were 56% (n = 50) males. Sixty-seven percent (n = 60) of patients ingested multiple magnets and or a magnet and a second metallic foreign body. The most common location identified on imaging was small intestine and/or colon (45%) followed by the stomach (42%). Only 39% were symptomatic and the most common symptom was abdominal pain.

Clinical management

Plain

Discussion

Magnet ingestion may not be the most common foreign body ingested but they require special attention and prompt management. Recently, reports of magnet ingestion complications including death have forced toy companies to recall certain magnetic toys [15], [16]. This prompted the United States Consumer Product Safety Commission to release a warning regarding high-powered magnets and proposed new federal standards [17], [18]. However, the North American Society for Pediatric Gastroenterology,

Conclusions

Magnets have a high risk of requiring intervention for removal, especially when multiple magnets or a magnet and a second metallic foreign body are ingested together. Given the management variability and lack of standardization, we developed an algorithm for management of magnet ingestions. Future prospective studies evaluating this algorithm are needed.

Acknowledgement

The authors thank Ashley Sherman, MA for her work with analyzing the results.

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    Citation Excerpt :

    Passage should be confirmed on X-ray.3,16 Sola and colleagues have a similar algorithm: they recommend nonurgent removal of any magnet in the esophagus and otherwise outpatient management of a single ingested magnet with a follow-up abdominal X-ray in 14 days if the magnet has not passed.23 If the magnet does not progress as expected, a high index of suspicion for undiagnosed multiple magnets should be maintained.

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All authors have no conflicts of interest to disclose regarding this study.

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