Surgical management and morbidity of pediatric magnet ingestions

doi:10.1016/j.jss.2015.04.007

Journal of Surgical Research

Volume 199, Issue 1, November 2015, Pages 137-140

https://doi.org/10.1016/j.jss.2015.04.007 Get rights and content

Abstract

Background

Foreign body ingestion remains a common reason for emergency room visits and operative interventions in the pediatric population. Rare earth magnet ingestion represents a low percentage of all foreign bodies swallowed by children; however, magnets swallowed in multiplicity can result in severe injuries.

Materials and methods

Pediatric surgeons with membership in the Surgical Section of the American Academy of Pediatrics were surveyed to determine the magnitude and consequences of magnet ingestions in the pediatric population.

Results

About 100 (16%) participant responses reported on 99 magnet ingestions. The median age at ingestion was 3.7 y, and the majority of ingestions (71%) occurred after year 2010. Thirty-two children underwent endoscopy with successful removal in 70% of cases, and multiple magnets were found in 65% of these patients. Seventy-three children required either laparotomy (51) or laparoscopy (22) for magnet removal, and 90% of these children were discovered to have ingested more than one magnet. In addition, 17% of the children were found to have at least one perforation or fistula, and 34% of the children had multiple perforations or fistulae. Nine children required long-term care for their injuries including repeat endoscopies. One child died after hemorrhage from an esophago-aortic fistula.

Conclusions

These results demonstrated the increasing need for magnet regulations and public awareness to prevent potentially serious complications.

Introduction

In children, most ingested foreign bodies will pass spontaneously through the gastrointestinal tract without incident; however, several reports describe significant sequelae associated with rare earth (or neodymium) magnet ingestions including obstruction, fistulae, and perforation due to pressure necrosis. Although magnet ingestion is rare, the incidence has climbed with the popularity of magnetic toys. An increasing number of ingestion incidents reported to the United States Consumer and Product Safety Commission resulted in establishment of a mandatory standard to prevent magnets from detaching from toys. This standard also prohibits magnets and loose magnet components in toys for children under age 14 y [1]. Unfortunately, despite this regulation, vendors via the Internet continue to sell these products. Additionally, there has not been a broad-based public education of the problems associated with these magnets that are already in sold to the public.

Single magnet ingestion may pass without complication, but multiple magnet ingestion commonly requires either endoscopy or surgical intervention. Accordingly, patients with known or suspected magnet ingestion require timely management as initial signs and symptoms are often nonspecific. Improved education and safety standards may decrease the chance of magnet ingestion and help prevent the subsequent complications. The aim of this survey was to better define the surgical interventions and outcomes of magnet ingestions in the pediatric population.

Section snippets

Materials and methods

After receiving institutional review board approval (X130327003), an online survey was developed and distributed via e-mail to all pediatric surgeons with membership in the Surgical Section of the American Academy of Pediatrics. The questionnaire consisted of 37 multiple choice questions regarding demographics, ingestion prevalence, diagnostics, endoscopic and surgical interventions, and outcomes related to cases that occurred during the past 10 y. Survey responses were collected anonymously by

Results

Approximately 630 surgeons were polled with 101 (16%) participant responses reporting on 99 magnet ingestions. Survey respondent's demographics ranged equally with regard to number of years in practice with 21% <5 y, 13% 5–10 y, 28% 11–20 y, and 38% >20 y. The majority (66%) characterized their practice as an academic medical center-based pediatric surgery practice. The majority of ingestions reported (72%) occurred after the year 2010 (Fig. 1). The median age at ingestion was 3.7 y with a

Discussion

The increasing numbers of magnet ingestions demonstrate an unrelenting public health concern. According to the 2012 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System, ingestion of foreign bodies remain in the top five of all human exposures with nearly 80,000 incidences reported to poison control in the pediatric population of age ≤5 y [2]. Although magnet ingestion remains fortunately rare, the National Electronic Injury Surveillance System

Acknowledgment

Authors' contributions: A.M.W. and E.A.B. did the analyzing of data and writing of the article. D.H.T. and E.A.B. contributed to the conceptualization of the study. D.H.T., V.T., A.B., and R.A.N. did the editing of the survey. D.H.T., A.B., E.A.B., and R.A.N. did the editing of the article. V.T. collected the data. E.A.B. did the writing survey.

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Cited by (49)

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2023, International Journal of Surgery Case Reports
Magnetic foreign body (FB) ingestion represents a significant health hazard among children. The increasing use of small attractive magnets as toys or parts of various household accessories makes it easily accessible to children. The aim of this report is to raise awareness of public authorities and parents around exposing children to magnetic toys.
We report a case of multiple FB ingestion in a 3-year-old child. Radiological imaging revealed multiple round objects arranged in a circular shape resembling a ring. Surgical exploration showed multiple intestinal perforations attributed to the magnetic attraction between the objects.
Although more than 99 % of ingested FB pass without surgical intervention, ingestion of multiple magnetic FB provides a substantially higher risk of injury due to self-association and therefore requires a more aggressive clinical approach. A stable or clinically benign condition, though common, does not necessarily mean a safe situation in the abdomen. Literature review suggests that emergency surgical intervention should be pursued to avoid potentially life-threatening complications; perforation and peritonitis.
Multiple magnet ingestion is rare, but can result in serious complications. We recommend early surgical intervention before gastrointestinal complications develop.
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2022, Anales de Pediatria
Las ingestas de objetos imantados pueden presentar complicaciones en el niño, no existiendo datos epidemiológicos ni clínicos en España.
Conocer la incidencia de ingesta de objetos imantados en los servicios de urgencias pediátricos españoles, sus características epidemiológicas y su manejo.
Estudio observacional prospectivo multicéntrico realizado durante 3 años. Población de referencia menores de 14 años.
La incidencia fue de 4,8/100.000 urgencias. De los 72 pacientes incluidos (edad media de 7,2 años), el 54% fueron varones. El 7% presentaron antecedentes neuropsiquiátricos. El 61% de los imanes fueron esféricos y el 69% procedían de juguetes. El tamaño fue variable con un predominio de los imanes entre 5 y 10 mm (50%). El 86% fueron asintomáticos. El síntoma más frecuente fue el dolor abdominal. El 83% de los pacientes consultaron en menos de 6 h y el 92% en las primeras 24 h. El 31% fueron ingestas múltiples. El 15% precisó intervención endoscópica, cifra que ascendió al 36% en los casos de ingestas múltiples. No se realizó ninguna intervención quirúrgica. No se observó ninguna complicación gastrointestinal secundaria.
Las ingestas de imanes múltiples son menos frecuentes que las simples y en este estudio no se han observado complicaciones a pesar de que las intervenciones realizadas han sido menores que en otros estudios.
The ingestion of magnetic objects can cause complications in children, and there are no epidemiological or clinical data on the subject in Spain.
To determine the incidence, epidemiological characteristics and management of magnet ingestion in paediatric emergency departments in Spain.
Prospective observational multicentre study conducted over a 3-year period. The study universe consisted of patients aged less than 14 years.
The incidence was 4.8 cases per 100 000 emergency care episodes. Of the 72 patients included (mean age, 7.2 years), 54% were male. Seven percent had neuropsychiatric disorders. Sixty-one percent of the magnets were spherical and 69% came from toys. The size was variable, most frequently between 5 and 10 mm (50%), and ranging from 3 to 30 mm. Eighty-six percent of patients were asymptomatic. The most frequent symptom was abdominal pain. Eighty-three percent of the patients sought medical care within 6 h of ingestion and 92% within 24 h. Thirty-one percent of the cases were of multiple ingestion. Endoscopy was required for extraction in 15% of cases, a proportion that rose to 36% in the group of cases of multiple ingestion. None of the patients required surgery. We did not observe any gastrointestinal complications of magnet ingestion.
The ingestion of multiple magnets is less frequent than single magnet ingestion, and we did not observe any complications despite the lower frequency of procedures compared to other studies.
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Multiple Ball Magnet Ingestion With Sandwiching of the Uvula
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Citation Excerpt :
On the contrary, two or more high-powered magnets progressing through the gastrointestinal tract tend to forcefully attract each other and so, lead to the interposition of bowel loops between them. This leads to an increased risk of intestinal obstruction, fistula formation, and perforation due to pressure necrosis, usually within hours after ingestion (3–5). Nonoperative management of asymptomatic foreign body ingestion of regular monitoring for spontaneous fecal passage.
Enteroenteric fistulae after ingestion of multiple magnets in children
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In our cases also there was a delay in presentation as the children were very young to express themselves and nobody witnessed the ingestion of magnets balls. They may also present with life-threatening GIT bleeding from an aortoesophageal fistula [18], bowel obstruction, volvulus, intestinal perforation, intestinal fistula, peritonitis, short-bowel syndrome caused by massive bowel resection, life-threatening injuries, and even death caused by ingestion of multiple magnets or co-ingestion of other metallic objects with a magnet [19–31] or may have no symptoms at all even with confirmed ingestion [4]. In one series the intestinal perforation rate was 50% [32].
Infants and young children explore objects by putting them in the mouth. Although most swallowed foreign bodies pass spontaneously through the gastrointestinal tract without causing harm, some of them are potentially dangerous and may be lethal.
Five children (3boys and 2girls) have swallowed multiple high strength and powerful rare earth element Neodymium magnets. Their ages ranged between (nine months to six-year-old). Three cases were subjected to open and two for laparoscopic exploration (one of them converted to open).
multiple complicated enteroenteric fistulae in three cases and multiple perforation of small intestine in two cases. Resection anastomosis was done for one case and simple closure of small bowel perforations for other four cases. Post operative course was uneventful for all patients and discharged in a good general condition.
General practitioners should be aware of the danger and complications of Neodymium magnetic beads ingestion by children. Early endoscopic removal is recommended if the patient presents immediately after ingestion. Parents awareness through media is required to abandon magnet balls in houses and where children can ingest those dangerous balls.
Accidental ingestion of multiple magnetic beads by children and their impact on the gastrointestinal tract: a single-center study
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Association for Academic SurgerySurgical management and morbidity of pediatric magnet ingestions

Abstract

Background

Materials and methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgment

Ann Emerg Med

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr

Association for Academic Surgery
Surgical management and morbidity of pediatric magnet ingestions