Multiple Magnet Ingestion

Emma Boylan

Mary Wyers, MD

Children's Memorial Hospital

Abstract

Abdominal pain

Keywords

1594, foreign body ingestion, multiple magnet ingestion SPR unknown case 27


Publication Date: 2010-02-24

History

8 y.o. male with abdominal pain.

Findings

There is a metallic foreign body in the right lower abdomen. The position had not significantly changed since a prior examination, which looked identical to this one.

Diagnosis

Multiple magnet ingestion. This case had associated ischemia of small intestine.

DDx

Other foreign objects swallowed.

Discussion

Multiple magnet ingestion is a special case of foreign body ingestion, a relatively common issue in pediatric populations. Most ingested foreign bodies can be expected to pass spontaneously, and are treated conservatively with close observation. However, 10-20% of patients may be subjected to endoscopic removal of the foreign body from the stomach or esophagus. Less than 1% of cases of foreign body ingestion require surgical removal of the object.

Multiple magnet ingestion, however, presents special risks including volvulus, bowel perforation or necrosis, and sepsis; these complications can result in death. Despite these serious complications, patients may present with vague or minimal physical symptoms and normal laboratory results. Magnets that have become attached may appear in x-rays as a single object that can be safely passed. Factors influencing the severity of the case include the number and strength of the magnets and the timing of ingestion; two magnets ingested at the same time may attach in the stomach and pass simultaneously. However, two magnets ingested at slightly different times can attach themselves together through the walls of adjacent loops of bowel, leading to perforation, necrosis, or obstruction.

For cases of multiple magnet ingestion, or ingestion of a single magnet and another metallic object, surgical removal of the objects is indicated to avoid or relieve serious complications. Clues that swallowed magnets may have become attached in the bowel include non-movement of the object on repeated images, or movement in a direction inconsistent with normal digestion. Vomiting, peritoneal signs, and abdominal pain indicate that the objects must be removed emergently.

References

  1. Alzahem AM, SS Soundappan, H Jefferies, DT Cass. Ingested magnets and gastrointestinal complications. Journal of Paediatrics and Child Health [serial online]. 2007;43(6):497-498. Accessed 24 February 2010.
  2. Dutta S, A Barzin. Multiple magnet ingestion as a source of severe gastrointestinal complications requiring surgical intervention. Archives of Pediatrics & Adolescent Medicine [serial online]. 2008;162(2):123-125. Accessed 24 February 2010.
  3. Saeed A, NS Johal, A Aslam, J Brain, RJ Fitzgerald. Attraction problems following magnet ingestion. Annals of the Royal College of Surgeons of England [serial online]. 2009;91(5):W10-W12(2). Accessed 24 February 2010.
  4. Wong HH, BA Phillips. Opposites attract: a case of magnet ingestion. Canadian Journal of Emergency Medicine [serial online]. 2009;11(5):493-495. Accessed 24 February 2010.

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