Endoscopic removal of impacted magnetic foreign bodies in the gastroesophageal junction

Ingestion of foreign bodies is common in gastroenterology practice. Most of them are spontaneously passed through gastrointestinal tract. However, ingestion of multiple magnets can cause serious complications, because magnets attract each other and they hold the gastrointestinal wall. Here, we describe a patient who ingested multiple magnets that attracted each other between distal esophagus, and a part of them was impacted into the esophageal wall. In general, impacted magnetic foreign bodies should be removed by surgical intervention because of a high perforation risk. But, in this case, we used an insulated-tip knife for endoscopic submucosal dissection technique to make an incision to expose the impacted magnetic foreign bodies, and removed them successfully without surgery. With this report, we hope to encourage gastroenterologists to consider this new technique as one of procedures for difficult cases, including impacted foreign bodies.     

An intestinal fistula in a 3-year-old child caused by the ingestion of magnets: Report of a case

We describe herein the case of a 3-year-old child in whom a jejunoileal fistula was caused by the ingestion of magnets. This case report demonstrates that if more than one magnet is found as a foreign body in the intestine, they should not be left untreated even if there are no sharp edges and, it seems they could be evacuated spontaneously. This recommendation is made because the magnets will attract each other and hold the intestinal walls between them, causing necrosis and resulting in intestinal perforation or a fistula.     

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.     

儿童误食磁性异物致消化道损伤的临床经验总结

目的:探讨儿童误食磁性异物致消化道损伤的临床特点、致病机制及诊治方法,为临床决策提供理论依据。方法:回顾性分析2017年10月—2021年9月安徽省儿童医院收治的46例消化道磁性异物患儿的临床资料,根据是否存在消化道穿孔将患儿分为消化道穿孔组( n＝28)和消化道未穿孔组( n＝18)。观察患儿...     

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.     

Unusual gastric foreign body: a case report

Ingestion of foreign bodies, either intentionally or accidentally, is quite common. The authors report an unusual case in which a 32-year-old man deliberately assembled a large metallic aggregate in his stomach by swallowing magnets and coins in order to relieve epigastric discomfort. The collection was retrieved by laparotomy and gastrotomy; a gastric ulcer was also found and it was oversewn. Management of this patient is discussed and the principles of treatment for ingested foreign bodies are reviewed.     

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.     

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.     

Laparoscopic retrieval of intraabdominal foreign bodies

The use of laparoscopy has been described as the means of removing intraabdominal foreign bodies, both intraperitoneal and intraluminal, from the stomach or bowel. An early report detailed the laparoscopic removal of translocated intrauterine devices from the peritoneal cavity [2]. Laparoscopic removal of a retained surgical sponge also has been reported [1]. For large ingested objects that cannot be retrieved by flexible endoscopy, laparoscopic gastrotomy and foreign body removal have been described [3] . The authors recently had three cases of laparoscopic foreign body retrieval. The first case involved a young man who had ingested latex gloves, causing gastrointestinal bleeding. Endoscopic retrieval was unsuccessful. A laparoscopic gastrotomy was performed, with the retrieval of four gloves, followed by intracorporeal, sutured closure of the gastrotomy. The second case involved the laparoscopic removal of a Penrose drain around the distal esophagus. The patient had initially undergone a laparoscopic Nissen fundoplication, vagotomy, and gastrojejunostomy for the management of reflux and a duodenal stricture. He had persistent dysphagia after surgery, prompting takedown of the fundoplication several months later. When his dysphagia did not improve, a retained Penrose drain that had been placed around the distal esophagus at the initial operation was discovered on computed tomography. This was removed laparoscopically. At this writing, 18 months after the initial operation, the patient has complete resolution of dysphagia. The third case involved a duodenojejunal fistula caused by multiple ingested magnets that had eroded through the bowel wall. The fistula was divided laparoscopically, and 16 disk-shaped magnets were removed. The duodenum and jejunum were repaired with laparoscopic suturing and stapling. All three patients did well after surgery. Laparoscopy can be an excellent method for abdominal foreign body retrieval. Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorized users.     

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.     

Transfer of the temporal muscle for lagophthalmos according to Gillies

For correction of lagophthalmos different methods have been described such as gold weights, palpebral spring and magnets. Using the transposed temporal muscle is superior to implantation of foreign material. We present a method for correction of lagophthalmos that combines static support with dynamic function. During the last eight years we performed transposition of the temporal muscle in 17 patients. The anterior part of the temporal muscle has been transposed. Corneal irritation and epiphora disappeared in all patients, although a complete correction of lagophthalmos could not be achieved in each case. Chewing was not impaired and closure of the eye could be performed independently from chewing. Because of its low morbidity the transfer of the temporal muscle is the procedure of choice for repair of lagophthalmos.     

Magnetic foreign body on the nasal septum

A 9-year-old boy presented to our department 8 days after attempting to insert a non-piercing magnetic ear stud on either side of his nose. He had been unable to remove them, and both magnetic parts of the ear studs were still present in his nose. Examination of the nose was difficult, as he was unco-operative and his nose was filled with mucus and crusts. X-rays of the nose revealed the two ear studs on either side of the nasal septum (Fig. 1). The magnets had caused compression and thinning of the septal cartilage. Examination under general anaesthesia revealed the two magnets embedded into the mucosa across the septum. The magnets were removed under general anaesthesia by clamping and sliding them in opposite directions. The exposed compressed cartilage was gradually covered by granulation tissue and eventually nasal mucosa.     

Transfer of the temporal muscle for lagophthalmos according to Gillies.

For correction of lagophthalmos different methods have been described such as gold weights, palpebral spring and magnets. Using the transposed temporal muscle is superior to implantation of foreign material. We present a method for correction of lagophthalmos that combines static support with dynamic function. During the last eight years we performed transposition of the temporal muscle in 17 patients. The anterior part of the temporal muscle has been transposed. Corneal irritation and epiphora disappeared in all patients, although a complete correction of lagophthalmos could not be achieved in each case. Chewing was not impaired and closure of the eye could be performed independently from chewing. Because of its low morbidity the transfer of the temporal muscle is the procedure of choice for repair of lagophthalmos.     

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.     

A New Method for Detecting the Abomasal Position and Characteristics of Movement at the Onset of the Left Displacement of the Abomasum in Cows

A new method has been developed by us to observe the movements of the abomasum by using a magnet and digital magnetometer. Four cows with left displacement of the abomasum underwent conventional correction by rolling without tacking. A doughnut‐type magnet was sutured to the pyloric region in a routine operation. The same was done in three control cows. The position of the pyloric region was observed with a digital magnetometer from outside the cow's body. The magnets in the pyloric region of the control cows were located at the right side of the abdominal cavity at 10–30 cm anterior to the udder base, and moved slightly in various directions within the span of a day. On the other hand, the magnets in the pyloric region of cows with abomasal displacement moved widely in the abdominal cavity from the normal right side to the abnormal left front side. A large movement of the magnet from the normal right side to the abnormal left side of the abdominal cavity was observed within 12 h of the onset of abomasal displacement.     

Magnetite tattoos

BACKGROUND AND OBJECTIVES: Tattoo removal is a significant problem. The extraction of magnetite (Fe(3)O(4)) ink tattoos by a magnetic field was investigated, with and without Q-switched laser treatment. STUDY DESIGN/MATERIALS AND METHODS: Magnetite particles (1.4 microm) were used to make mature, black skin tattoos on hairless albino rats. A Q-switched ruby laser (QSRL) 3.5 J/cm(2), 6.5-mm spot size, 40-nanosecond pulse width was used for treatment. Permanent magnets (1.4 T, 6-mm diameter) were tested to extract the magnetite particles, alone and after QSRL. Lightening of treated tattoos was measured from digital photographs, and the amount and distribution of magnetite in skin biopsies was scored blindly. RESULTS: External application of magnets on mature magnetite tattoos without prior QSRL treatment, did not significantly extract, lighten, darken, or change their histologic appearance. A magnetic field applied immediately after QSRL treatment extracted some ink when epidermal injury was present, and caused significant redistribution of magnetite into the upper dermis with vertical banding along magnetic field lines. When applied for 3 weeks following QSRL, magnets caused darkening of tattoos. CONCLUSIONS: Magnetite skin tattoos can be manipulated by external magnets, especially after Q-switched laser treatment. Magnetically-extractable tattoos may be feasible.     

Application of magnets in total knee arthroplasty surgery

A case is described in which magnets were employed to facilitate the use of the extramedullary jig in total knee arthroplasty in the presence of a femoral deformity.     

MCRA of an anastomotic stenosis after esophagoesophagostomy for long gap esophageal atresia: a case report

A 25-month-old boy with long gap esophageal atresia developed severe esophageal stenosis refractory to balloon dilatations after definitive esophagoesophagostomy. At 33 months of age, the patient had a magnetic compression revision anastomosis, in which a pair of 2 cylindrical Samarium-cobalt rare-earth 320 mT (3200 G) magnets, 15 × 5 mm (diameter × thickness), were placed in the esophagus to compress the scar tissue of the anastomosis. The magnets were retrieved 34 days after the magnetic compression revision anastomosis procedure. For 3 months, the patient subsequently had balloon dilatations to prevent restenosis, and he has been able to eat normally by mouth without further balloon dilatations since then.     

Pediatric magnet ingestions: the dark side of the force

Background

Pediatric magnet ingestions are increasing. Commercial availability of rare-earth magnets poses a serious health risk. This study defines incidence, characteristics, and management of ingestions over time.

Methods

Cases were identified by searching radiology reports from June 2002 to December 2012 at a children's hospital and verified by chart and imaging review. Relative risk (RR) regressions determined changes in incidence and interventions over time.

Results

In all, 98% of ingestions occurred since 2006; 57% involved multiple magnets. Median age was 8 years (range 0 to 18); 0% of single and 56% of multiple ingestions required intervention. Compared with 2007 to 2009, ingestions increased from 2010 to 2012 (RR = 1.9, 95% confidence interval 1.2 to 3.0). Intervention proportion was unchanged (RR = .94, 95% confidence interval .4 to 2.2). Small spherical magnets comprised 26.8% of ingestions since 2010; 86% involved multiple magnets and 47% required intervention.

Conclusions

Pediatric magnet ingestions and interventions have increased. Multiple ingestions prompt more imaging and surgical interventions. Magnet safety standards are needed to decrease risk to children.