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.     

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.     

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.     

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.     

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.     

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.     

Attraction Problems Following Magnet Ingestion

Ingestion of magnetic toys is associated with serious complications that can result in pressure necrosis and bowel perforation. We report three cases of multiple (more than two) magnet ingestion. In two patients, the symptoms did not resolve and complications of perforation and jejunocolic fistula occurred. The third patient, however, had early intervention with no resultant complication. The literature is reviewed and close observation and early surgical intervention is recommended.     

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...     

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.     

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.     

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.     

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.     

Needle perforation of the bowel in childhood

Accidental ingestion of foreign bodies occurs frequently in childhood. The majority of them are passed spontaneously, and conservative management generally is recommended for foreign bodies in the stomach and duodenum. However, in some cases, operative intervention should be considered to prevent undesirable complications, such as intestinal perforation. Two cases of intestinal perforation owing to accidental ingestion of a needle are reported.     

The contraindications for blind esophageal bouginage for coin ingestion in children

Per oral bouginage of the esophagus for coin lodgement in children is a safe and simple mode of therapy. However, our experience with chronically ingested coins, multiple coins ingestion, and ingestion with preexisting esophageal pathology illustrate the potential hazards of such a practice. Intramural perforation, subacute mediastinitis, tracheoesophageal fistula, and long-term residual injury to the esophagus hallmark such cases. We believe that only acutely ingested coins, and only a single coin, can be treated safely by means of "blind" bouginage, provided that no preexisting esophageal disease is present.     

Aortoesophageal perforation following ingestion of razorblades with massive haemothorax.

Aortoesophageal fistula is a rare complication of foreign body ingestion. Typically having ingested a fish or chicken bone, the patient complains of chest pain or discomfort and/or may present with massive gastrointestinal bleeding, which in all but rare cases is fatal. The pathological mechanism may involve perforation and direct communication of oesophagus and aorta usually at the level of the aortic arch; or more usually following oesophageal perforation, the subsequent mediastinal abscess leads to necrosis of the aortic wall. Torrential haemothorax as a result of such a process has not been previously described, though it has undoubtedly occurred. We present a case of massive haemothorax following deliberate ingestion of razorblades that highlights clinically and radiologically the natural course of such a tragic action.     

Lethal Intestinal Perforation After Foreign Body Ingestion in a Superobese Patient

Accidental ingestion of foreign bodies is common in the general population. Most foreign bodies pass through the entire digestive tract without incidents. However, in some cases, the ingested foreign body can cause complications such as acute abdomen due to intestinal perforation and even death. Bowel perforation may not be more common in the massively obese than in the normal-weight population but may be more problematic. We describe a super-obese female (body mass index, 52.3 kg/m²) who underwent emergency surgery for small-bowel perforation caused by an ingested foreign body (fish bone); the patient died despite segmental intestinal resection and intensive care.     

基于磁压榨技术的无创化胃造瘘的大鼠模型研究

背景与目的 胃造瘘术是普通外科常见手术,传统胃造瘘术创伤大,已逐步被内镜下胃造瘘、X线下胃造瘘术取代,但实施过程需要内镜系统或X线机辅助,且操作较为繁琐。基于应用磁压榨技术行无创化胃造瘘的设想,本研究采用自行设计加工的胃造瘘磁体装置,在大鼠模型上验证该设想的可行性和安全性。方法 根据大鼠消化道解剖特点和尺寸自行设计加工适合于大鼠胃造瘘的钕铁硼子母磁体,电子万能试验机测试子母磁体的磁力学曲线。10只SD大鼠麻醉后经口置入子磁体至胃内,在大鼠左上腹部放置母磁体,子母磁体自动吸合,腹部X线明确磁体相吸情况。术后单笼饲养,观察大鼠存活状况、磁体脱落时间、磁体留置期间并发症发生情况。术后2周处死动物,获取造瘘口标本,肉眼及光镜下观察造瘘口形成情况。结果 设计和生产出的子母磁体均为圆柱状,采用N42烧结钕铁硼加工而成,表面电镀镍防护处理。子磁体直径5 mm、高3 mm,母磁体直径6 mm、高5 mm,子母磁体质量分别为0.410 g和1.035 g。子母磁体在零距离时最大吸力达4.36 N,磁体吸力随位移增加而逐渐减小。10只大鼠麻醉后均成功经口置入子磁体至胃内,在大鼠左上腹部放置母磁体后,子母磁体迅速相吸,腹部X线检查显示磁体对位吸合良好。术后大鼠均存活,子母磁体留置期间,未出现磁体移位、子母磁体分离等意外事件,所有实验动物无消化道梗阻、腹腔感染等并发症。术后10~13 d子母磁体脱落,胃造瘘通道建立。术后2周开腹观察可见造瘘口处胃壁和腹壁粘连愈合牢固,腹腔无渗液及粘连。获取造瘘口标本肉眼可见瘘口形成良好,HE及Masson染色光镜下观察可见瘘口组织结构层次清晰。结论 基于磁压榨技术的胃造瘘磁体设计巧妙、易于加工、成本低,该方法建立无创化大鼠胃造瘘操作简单,安全可行,造瘘口各层组织愈合良好。下一步可开展与人体解剖特点更接近的大动物实验验证其可行性并评价造瘘口形成的长期效果。未来优化磁体设计和操作路径后,该技术有望在临床试用开展。     

Vinyl glove ingestion in children: a word of caution

BackgroundVinyl gloves when ingested will harden and develop sharp edges producing gastric bezoars; bowel obstruction; and, ultimately, perforation. We report 4 children with complications secondary to vinyl glove ingestion who required surgical intervention.MethodsA 3-year-old boy, a 13-year-old adolescent girl with Down syndrome, a 14-year-old adolescent girl, and a 15-year-old adolescent boy presented with bowel obstruction secondary to a bezoar caused by a vinyl glove. The adolescent girl with Down syndrome presented again at age 17 years with a large vinyl glove gastric bezoar. Three of the children had mental retardation, and 1 was a victim of child abuse. Three had laparoscopic-assisted removal of the vinyl glove bezoar, and 1 had laparotomy.ResultsThe 4 children recovered uneventfully. Two of the patients had unsuspected intestinal perforation. The caretakers denied awareness of the vinyl glove ingestion.ConclusionsVinyl glove ingestion can cause intestinal obstruction and perforation. Vinyl gloves should be removed from the immediate proximity of mentally retarded patients or patients with pica. Most of the time, the finding of vinyl gloves as etiology of the obstruction or perforation is incidental. If the event is known or witnessed, prompt surgical intervention is generally recommended.