An intestinal volvulus caused by multiple magnet ingestion: an unexpected risk in children

It has been reported that ingested magnets can cause intestinal fistula formation or perforation, leading to intestinal obstruction. However, there are no previous case reports that magnet ingestion additionally caused an intestinal volvulus. We report herein the case of a 1-year-old boy in whom the ingested magnets caused a volvulus of part of the small intestine leading to the resection of the necrotic portion. We think that if more than one magnet is found as a foreign body in the intestine, they should be removed immediately by laparotomy. Clinicians who care for children should be aware of this unexpected risk.     

Small bowel complication caused by magnetic foreign body ingestion of children: two case reports

Accidental ingestion of foreign bodies is a common pediatric problem. The majority of such cases occur between 6 months and 3 years. When several magnets are ingested, they can be attracted to each other through the intestinal wall, causing necrosis and intestinal perforation or fistula, so they should be removed while they are still in the stomach. The authors experienced 2 cases of unusual small bowel complication caused by the ingestion of magnets. The first case was in a 10-month-old boy with ileal perforation caused by to 2 ingested magnetic beads, and the second case was in a 22-month-old boy with ileo-ileal fistula caused by to 7 ingested magnetic beads.     

Intestinal perforation caused by magnetic toys

Accidental ingestion of foreign bodies is a common problem in children, but ingestion of magnets is rare. When multiple magnets are ingested, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation, or intestinal obstruction; as has been reported in 13 cases in the past 10 years. We report the fifth case in the literature of intestinal perforation and fistula caused by the ingestion of 2 small magnetic pieces of a toy by a 3-year-old boy. We find it necessary that sanitary authorities give more information to parents and physicians about the potential risks of these magnetic toys.     

Magnetic attraction: dual complications in a single case

A case report of a 19-years-old mentally retarded girl, presented with abdominal pain, nausea and vomiting of two days duration. Physical examination revealed abdominal tenderness with guarding and rigidity. Exploratory laparotomy revealed the presence of magnets in the jejunum with perforation of jejunum and a resultant gastro jejunal fistula. The procedure involved enterotomy for removal of magnets, resection of the segment of the bowel with fistula and perforation and end-to-end anastomosis. The association of ingested magnets, leading to dual complications, is a rare case ever reported in Dubai.     

Laparoscopic retrieval of "stubborn" foreign bodies in the foregut: a case report and literature survey

INTRODUCTION: Foreign bodies (FBs) are commonly seen in pediatric and gastroenterologist practice. Most of them will pass without intervention; those that do not will need surgery. Laparoscopy has been used to achieve this to good effect. We present a child with ingestion of multiple magnets. CASE REPORT: The patient was a 2-year-old child with history of ingestion of magnets. Laparoscopy was planned as endoscopic removal had failed. There were 3 magnets in the stomach and 1 in the jejunum and they were attached together, as if in a "gastrojejunostomy." Laparoscopic removal was performed successfully for the child. RESULTS: He had an uneventful postoperative recovery and was discharged on the third postoperative day. DISCUSSION: Coins are the most commonly ingested FBs. Multiple magnet ingestion poses a unique problem, as they are likely to stick together and cause pressure necrosis with fistula formation. Surgical intervention is necessary to prevent this potentially deadly complication. CONCLUSIONS: Laparoscopy has been found to be very useful in the removal of intraluminal FBs, especially when conservative measures fail. Prevention should be the main objective and parental involvement is crucial.     

Intestinal perforation due to multiple magnet ingestion: a case report

Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets may stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces. An eight-year-old girl presented with abdominal pain and vomiting. She had abdominal tenderness and defense on the physical examination. Abdominal X-ray showed air and fluid levels. Metallic images were not considered at first as important in the diagnosis. Abdominal ultrasonography was reported as acute appendicitis. During the abdominal exploration, the appendix was normal, but there were dense adherences around the ileum and cecum. After adhesiolysis, intestinal perforations were seen in the cecum and 15 and 45 cm proximal to the cecum. Magnet and metal pieces were present in the perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications, and she was discharged on the postoperative fifth day. Pediatric surgeons should be aware of the complications of multiple magnet ingestion. If the patient has a history of multiple magnet ingestion, follow-up with daily abdominal X-rays should be done, and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered.     

Malignant duodenocolic fistula: Report of a case and considerations for operative management

Malignant duodenocolic fistula is a rare complication of gastrointestinal malignancy. We present herein the case of a 34-year-old female in whom a large duodenocolic fistula was caused by advanced transverse colonic carcinoma. Right hemicolectomy combined with pancreaticoduodenectomy enabled en bloc resection of the tumor, and the patient has been free of disease for 1 year and 8 months postoperatively. A review of the international literature, including 33 cases reported in Japan, indicates that if the disease is curable, the treatment of choice is right hemicolectomy with pancreaticoduodenectomy, whereas if it is not curable but locally resectable, the best palliation appears to be right hemicolectomy with partial duodenectomy to include the fistulous tract. Dehiscence of the duodenal wound closure associated with partial duodenectomy can be prevented by using the mucosal or serosal patch techniques with intestinal loops. These therapeutic principles are also applicable for colonic carcinoma which massively involves the duodenum without fistula formation.     

Intestinal Volvulus and Perforation Caused by Multiple Magnet Ingestion: Report of a Case

Ingested magnets can cause intestinal fistulas, perforation, and obstruction. There have been reports of magnet ingestion causing intestinal volvulus, but multiple magnet ingestion causing perforation and intestinal volvulus in a child is very unusual. We report the case of a 4-year-old girl, who ingested four magnets she acquired as toys, which caused intestinal volvulus and perforation as a result of pressure necrosis, several days after ingestion. At surgery we repaired two perforations, but additional bowel resection was not required. The patient was discharged on postoperative day 10. If multiple magnet ingestion is suspected in a child, the child must be monitored carefully. If there are signs of obstruction, emergency surgery is mandatory.     

Ingestion of magnets: innocent in solitude, harmful in groups

Foreign body ingestion is frequent in children and generally associated with little morbidity. However, some foreign bodies are innocent when ingested as a single object, but may have harmful effect if numerous. We report a 9-year-old girl who swallowed 5 magnets, causing acute intestinal obstruction. At laparotomy, 2 magnets were found in the cecum and 3 in the transverse colon, attracting each other and clasping a segment of ileum in between, causing a complete obstruction of the small intestine. If numerous magnets are ingested, particular concern is advised, and if signs of intestinal distress develop, prompt laparotomy to prevent serious gastrointestinal complications should be performed.     

Enterohepatic fistula in a Crohn’s disease patient: A case report

IntroductionFistulous tracts are a hallmark of Crohn’s Disease. However, solid organ to intestinal fistulas are rare with previously few case reports of colosplenic fistulas and one case report of an enterohepatic fistula.Presentation of caseWe review the available literature and present the first case report of an enterohepatic fistula in a female with Crohn’s Disease to be treated operatively. The patient did well postoperatively with complete resolution of her fistula.DiscussionCrohn’s Disease is an inflammatory bowel disease that can present with fistulas. However, a fistula between the liver and bowel is exceedingly rare with only one previous case report. This is the first report of an enteroheptic fistula that has been managed successfully with an operation.ConclusionNot all enteroenteric fistulas are apparent preoperatively. When discovered, laparoscopic enterohepatic fistula takedown is feasible for this rare disease process manifestation.     

Superior mesenteric arteriovenous fistula: Report of a case and review of the literature

Iatrogenic arteriovenous fistula of the superior mesenteric vessels is rare, with only 22 cases being documented. We report herein a case of a 63-year-old man with an iatrogenic arteriovenous fistula which developed after a small bowel resection for intestinal tuberculosis. The patient was admitted to our hospital for a gastric ulcer, at which time an ultrasonogram demonstrated cystic dilatation of the superior mesenteric vein, proving to be an arteriovenous fistula of the mesenteric vessels. An angiogram of the superior mesenteric vessels subsequently confirmed this diagnosis and resection of the fistula was performed, followed by an uneventful recovery. Iatrogenic mesenteric arteriovenous fistula with no presenting symptoms, as in our case, is uncommon and surgery performed before the development of associated portal hypertension should achieve good results. A review of the literature follows the report of this case.     

Bilateral spontaneous perilymph fistulae: a diagnostic and management dilemma

In this article, we present a case of bilateral perilymph fistulae. This entity is rare and always presents a diagnostic problem. Bilateral perilymph fistulae are more common in children and should be suspected when bilateral ear symptoms and congenital temporal bone radiographic anomalies are present. Previous trauma or barotrauma may be absent. When a patient manifests bilateral ear symptoms and a fistula has been identified and repaired in one ear, a second fistula should be suspected in the contralateral ear, especially if the fistula test is positive.     

Jejunal-rectal fistula as a complication of postoperative radiotherapy

We present the case of a patient with an unusual, complex enteric fistula with multiple tracts and associated abscesses. The fistula was a late complication of radiotherapy, administered three years earlier, after resection for carcinoma of the sigmoid colon. Most of the small bowel was involved in the radiation-induced disease. A wide resection was performed successfully. This report reviews current literature on intra-abdominal postradiotherapy injuries, particularly intestinal fistulae.     

胆总管下端术后十二指肠瘘19例治疗分析

目的：了解胆总管下端手术后十二指肠瘘发生的原因及处理。方法：回顾性分析1975－2002年收治的19例胆总管下端手术后十二指肠瘘发生的原因，诊断和治疗。十二指肠瘘经确诊后均经手术治疗。治疗方式：脓肿引流13例，十二指肠修补5例，胃大部切除幽门旷置胃空肠吻合，空肠造口1例。结果：十二指肠瘘治愈15例，死亡4例，死亡原因：消化道大出血2例，腹膜后严重感染1例，并发重症胰腺炎1例。结论：行胆总管下端探查操作时应谨慎，避免发生医源性损伤。十二指肠后早期诊断尤为重要，十二指肠瘘手术以引流为主，并予以充分的肠内营养支持。     

Vesicocutaneous Fistula Presenting Groin Abscess and Chronic Osteomyelitis in Pubic Bone

The authors report a case of bladder fistula associated with a medial thigh cutaneous fistula and chronic osteomyelitis of the pubic bone 11 years after surgery for a pelvic bone fracture and bladder rupture. In the presenting case, despite the clinical suspicion, none of the diagnostic tools demonstrated the bladder fistula preoperatively. This case suggests that bladder repair should be prepared, even if the bladder fistula cannot be confirmed by imaging studies because the amount of urine leakage can be minimal or the fistula can close spontaneously.     

The parachute design as a new extraperitoneal method of closing a recalcitrant high-output enterocutaneous fistula: report of a case

We introduce a new method for closure of a recalcitrant high-output jejunal enterocutaneous fistula. First, a transposed rectus abdominis muscle is sutured into the fistula opening using a parachuting technique, then the muscle is covered with a skin graft and temporarily immobilized to the fistula wall and abdominal wall with a negative pressure device. This extraperitoneal method provides tension-free closure of the fistula with well-vascularized tissue, without compromising the intestinal lumen. No bowel is resected. This new technique allows for early mobilization and recommencement of enteral nutrition.     

A paraprosthetic-enteric fistula associated with a duodenal tumor

An unusual etiology and presentation of a paraprosthetic-enteric fistula is reported involving a duodenal tumor. Review of the possible mechanisms of graft-enteric fistula formation and diagnostic evaluation is presented. Initial insertion of an extraanatomic bypass followed by graft excision was performed in the present case and is encouraged in hemodynamically stable patients. Additionally, resection of the eroded duodenum with end-to-end anastomosis was performed in order to restore intestinal continuity.     

Toy magnet ingestion in children: revising the algorithm

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.     

A case of biliary ileus in a subject who had already undergone cholecystectomy

A rare case of biliary ileus in an already cholecystectomized subject is reported. Apart from the rarity of the case, the failure to evidence a bilio-digestive fistula intraoperatively is pointed out and a trans-choledochal migration mechanism for the gallstone is hypothesised. After a short review of the main complications connected with this serious form of intestinal occlusion, stress is laid on the advisability of carrying out, especially in emergency situations, simple entero-lithotomy, confining more invasive surgery, such as the repair of the biliodigestive fistula or cholecystectomy to cases in which recurrent biliary pathology is evident.