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Ardila S, Woodley L, Ulloa E, Fernandez J, Bornstein J, Seims A. Utilization of Single-Incision Laparoscopy in the Management of Ingested Magnets. J Laparoendosc Adv Surg Tech A 2024; 34:530-534. [PMID: 38016150 DOI: 10.1089/lap.2023.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Background: A ban on neodymium magnets was lifted by the U.S. Consumer Product Safety Commission in 2016. Pediatric gastroenterologists and surgeons were increasingly tasked with removing these problematic objects. The purpose of this study was to assess the utility of single-incision laparoscopic surgery (SILS) in the management of ingested magnets. Patients and Methods: This is a single-center, retrospective assessment of surgical interventions for ingested magnets. International Classification of Disease, 10th revision codes were used to identify 349 patients ≤21 years of age evaluated for foreign body ingestion over a 4.5-year period. A medical record review helped isolate 29 (8.3%) magnet ingestions, 9 requiring surgical intervention. RedCap was used for analysis. Results: Of 9 surgical patients, 7 underwent SILS intervention by 1 surgeon. Another surgeon performed an open operation, whereas a third performed a multiport operation. Of the 7 SILS cases, 3 were completed without conversion to open. In one of these cases, bowel resection with primary anastomosis was performed. For SILS cases, average operating room time was 109 minutes (38-170 minutes), time to enteral feeds was 23 hours (0.28-79.2 hours), and hospital length of stay (LOS) was 3.8 days (1.96-6.68 days). Thirty-day readmission for SILS was 14.3%. No other complications were observed. Conclusions: SILS has been safely utilized for magnet retrieval. It offers an ability to identify the affected intestinal segment and an opportunity to intervene extracorporeally through an uncapped port. In addition, knowing where matted bowel is located can direct a limited incision during conversion to laparotomy. This may confer benefits of decreased pain, shortened time to enteral feeds, and decreased hospital LOS.
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Affiliation(s)
- Sara Ardila
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Lucille Woodley
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Emily Ulloa
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Jenelle Fernandez
- Department of Gastroenterology, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Jeffery Bornstein
- Department of Gastroenterology, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Aaron Seims
- Department of Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
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Mili T, Charieg A, Ahmed YB, Marzouki M, Nouira F, Jlidi S. A case report of multiple foreign body ingestion with a ring-like configuration: The magnetic effect. Int J Surg Case Rep 2023; 106:108177. [PMID: 37058800 PMCID: PMC10130618 DOI: 10.1016/j.ijscr.2023.108177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION 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. CASE PRESENTATION 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. CLINICAL DISCUSSION 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. CONCLUSION Multiple magnet ingestion is rare, but can result in serious complications. We recommend early surgical intervention before gastrointestinal complications develop.
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Affiliation(s)
- Takwa Mili
- Department of Pediatric Surgery "B", Bechir Hamza Children's Hospital, Tunis, Tunisia.
| | - Awatef Charieg
- Department of Pediatric Surgery "B", Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Yosra Ben Ahmed
- Department of Pediatric Surgery "B", Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Maryem Marzouki
- Department of Pediatric Surgery "B", Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Faouzi Nouira
- Department of Pediatric Surgery "B", Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Said Jlidi
- Department of Pediatric Surgery "B", Bechir Hamza Children's Hospital, Tunis, Tunisia
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Advantages of Fluoroscopy for Accidental Ingestion of Multiple Magnets. Case Rep Pediatr 2023; 2023:1512514. [PMID: 36910864 PMCID: PMC9995182 DOI: 10.1155/2023/1512514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
Foreign body ingestion is one of the common problems among children. A three-year-old girl presented to the emergency department 2 h after ingesting three small disk-type neodymium magnets. She had no gastrointestinal symptoms. Abdominal radiography revealed a foreign body in the left upper quadrant, which was the three circular magnets. Fluoroscopy was performed. She was placed in the right lateral decubitus position for 3 min and slowly returned to the supine position. Abdominal fluoroscopy revealed a foreign body migrating near the middle of the spine. Similarly, when she was placed in the left lateral decubitus position for 3 min and slowly returned to the supine position, the foreign body migrated to the outermost part of her left upper quadrant. Thus, we anticipated that the magnets could be excreted spontaneously. The patient did not develop any gastrointestinal symptoms after returning home, and two days later, three overlapping magnets were finally found in her stool. During accidental ingestion of single or multiple desk-type neodymium magnets, endoscopic removal may not be necessary if they are mobile and clump together in the stomach. Regarding the ingestion of multiple desk-type neodymium magnets, fluoroscopy is useful to determine the extent of endoscopic intervention.
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Azzam A, Sekaran P, Folaranmi SE. A very challenging scenario of 52 ingested toy magnets causing multiple entero-enteric fistulas in a year-old child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Falcon AC, Fernández-Valdes L, Iglesias C, Saps M. Magnet ingestion knows no borders: A threat for Latin American children. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:292-296. [PMID: 34794926 DOI: 10.1016/j.rgmxen.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS The ingestion of foreign bodies, such as magnets, is a potentially lethal accident that affects children and is associated with bleeding and gastrointestinal perforation, as well as death. There are no Latin American reports in the literature on cases of magnet ingestion in children. Our aim was to establish whether said ingestion has been seen by pediatric endoscopists and gastroenterologists in Latin America, to determine the scope of that potential threat in their patient populations. MATERIALS AND METHODS We collected data regarding endoscopies performed on children in Latin America, within the time frame of 2017-2019, through questionnaires that were distributed to pediatric endoscopists at the 2nd World Congress of Gastrointestinal Endoscopy (ENDO 2020). The questionnaires provided information on foreign body location, the presence and number of ingested magnets, and the description of complications and surgical interventions. RESULTS Our cohort from 12 Latin American countries reported 2,363 endoscopies due to foreign body ingestion, 25 (1.05%) of which were the result of having swallowed one or more magnets. Mean patient age was 5.14 years (SD 2.5) and 10 (40%) of the cases were girls. Three (12%) of the patients presented with severe complications and 2 (8%) cases required surgery. CONCLUSIONS Our preliminary study suggests that the ingestion of magnets is not common in Latin American countries, but said cases are frequently associated with complications. Constant monitoring of the incidence of such cases is extremely important, so that through education and awareness of those events, life-threatening complications in children can be prevented.
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Affiliation(s)
- A C Falcon
- Departamento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - L Fernández-Valdes
- Departamento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - C Iglesias
- Departamento de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Pereira Rossell, Montevideo, Uruguay
| | - M Saps
- Departamento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Falcon AC, Fernández-Valdes L, Iglesias C, Saps M. Magnet ingestion knows no borders: A threat for Latin American children. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 87:S0375-0906(21)00074-4. [PMID: 34538505 DOI: 10.1016/j.rgmx.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND AIMS The ingestion of foreign bodies, such as magnets, is a potentially lethal accident that affects children and is associated with bleeding and gastrointestinal perforation, as well as death. There are no Latin American reports in the literature on cases of magnet ingestion in children. Our aim was to establish whether said ingestion has been seen by pediatric endoscopists and gastroenterologists in Latin America, to determine the scope of that potential threat in their patient populations. MATERIALS AND METHODS We collected data regarding endoscopies performed on children in Latin America, within the time frame of 2017-2019, through questionnaires that were distributed to pediatric endoscopists at the 2nd World Congress of Gastrointestinal Endoscopy (ENDO 2020). The questionnaires provided information on foreign body location, the presence and number of ingested magnets, and the description of complications and surgical interventions. RESULTS Our cohort from 12 Latin American countries reported 2,363 endoscopies due to foreign body ingestion, 25 (1.05%) of which were the result of having swallowed one or more magnets. Mean patient age was 5.14years (SD2.5) and 10 (40%) of the cases were girls. Three (12%) of the patients presented with severe complications and 2 (8%) cases required surgery. CONCLUSIONS Our preliminary study suggests that the ingestion of magnets is not common in Latin American countries, but said cases are frequently associated with complications. Constant monitoring of the incidence of such cases is extremely important, so that through education and awareness of those events, life-threatening complications in children can be prevented.
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Affiliation(s)
- A C Falcon
- Departmento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos
| | - L Fernández-Valdes
- Departmento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos
| | - C Iglesias
- Departamento de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Pereira Rossell, Montevideo, Uruguay
| | - M Saps
- Departmento de Gastroenteología, Hepatología y Nutrición Pediátrica, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos.
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Mostafa MS, Darwish AA. Magnet ingestion in children and its implications: tertiary centre experience. Pediatr Surg Int 2021; 37:937-944. [PMID: 33839906 DOI: 10.1007/s00383-021-04889-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Swallowing multiple magnets or a magnet and second metallic object can carry risks of intestinal obstruction, fistula and perforation because they can attach to each other with loop of bowel in between. An updated management plan and reviewing our experience are warranted because of increased incidence of magnets ingestion among children. METHODS All the patients who had a history of single, multiple magnet or single magnet and second metallic object ingestion in Bristol Royal Hospital for children during the period from January 2014 till November 2020 were included in our study. RESULTS A total of 46 patients were referred to our hospital with a history of magnet ingestion. The number of magnets ingested ranged between one and twenty one magnets. All patients had abdominal x-ray undertaken either Antero-posterior alone (AP) (n = 32) or both AP and lateral (n = 14). Surgical intervention was performed in 18 patients; Oesophago-gastro-duodenoscopy (n = 8), laparotomy/laparoscpy (n = 10) to retrieve the magnets or deal with the complications. CONCLUSIONS Magnets ingestion in children can be tricky when it comes to management. Complications can happen quite often and carry severe risks on children. An updated structured algorithm is proposed to manage children with magnet ingestion.
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Affiliation(s)
- Mohamed Saber Mostafa
- Paediatric Surgery Department, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, BS28BJ, UK.,Paediatric Surgery Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Ahmed A Darwish
- Paediatric Surgery Department, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, BS28BJ, UK. .,Paediatric Surgery Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt.
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Multiple magnet ingestion: Ring-like configuration with multiple intestinal fistulae. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Arshad M, Jeelani SM, Salim A, Hussain BD. Multiple Magnet Ingestion leading to Bowel Perforation: A Relatively Sinister Foreign Body. Cureus 2019; 11:e5866. [PMID: 31763089 PMCID: PMC6834100 DOI: 10.7759/cureus.5866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Foreign body ingestion is a common reason for seeking emergency care among children. One of the more serious foreign bodies are the ingestion of multiple magnets or concurrent ingestion of a magnet and a metallic foreign body. Conservative management with serial imaging can be misleading in such cases. Multiple magnets tend to have strong attractive forces among them and may encase loops of bowel within them. Once entrapped, pressure necrosis and perforation will ensue, and thus, a low threshold should be adopted for surgical exploration in such cases. We present the case of a two-year-old male who had an accidental, unwitnessed ingestion of multiple magnets and also report the subsequent surgical management and associated morbidity.
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Affiliation(s)
- Muhammad Arshad
- Pediatric Surgery, Aga Khan University Hospital, Karachi, PAK
| | | | - Areej Salim
- Pediatric Surgery, Aga Khan University Hospital, Karachi, PAK
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Taher H, Azzam A, Khowailed O, Elseoudi M, Shaban M, Eltagy G. A case report of an asymptomatic male child with multiple entero-enteric fistulae post multiple magnet ingestion. Int J Surg Case Rep 2019; 58:50-53. [PMID: 31005048 PMCID: PMC6476807 DOI: 10.1016/j.ijscr.2019.03.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/13/2019] [Accepted: 03/21/2019] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Foreign body ingestion cases are very common in children. They usually present with obvious symptoms allowing proper diagnosis and management; however, magnet ingestion can be asymptomatic. This disorder is considered uncommon as well as challenging to diagnose before complications of intestinal obstruction or peritonitis occur due to entrapment of intestinal walls in the magnetic field. CASE PRESENTATION An asymptomatic four-year-old male child was admitted to our centre after passing two bullet-shaped magnets in stool that were noticed by his mother. The child was asymptomatic. An abdominal X-ray revealed five bullet-shaped magnets in the lower abdomen. Laboratory investigations were normal except for a mild leukocytosis. Surgery was performed with excision of seven entero-enteric fistulae and two intestinal anastomoses. DISCUSSION Between 2003 and 2006, the Centers for Disease Control and Prevention reported 20 complicated cases of magnet ingestion in children aged 10 months to 11 years among whom 75% had bowel perforations, and 20% suffered from generalized peritonitis. Half that number of patients required emergency laparotomy. As a result, the Consumer Product Safety Commission (CPSC) issued the first warning announcing the hazards of high-powered magnets used in children's toys, which had been increasing exponentially. It is clear that the diagnosis of magnet ingestion is made commonly due to complications, such as peritonitis or death. However, the patient in this case was completely asymptomatic and had no complications. CONCLUSION A high index of suspicion regarding complications is recommended in asymptomatic cases of suspected magnet ingestion. Avoid delaying intervention once a diagnosis has been made.
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Affiliation(s)
- Heba Taher
- Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
| | - Ahmed Azzam
- Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Omneya Khowailed
- Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Mohamed Elseoudi
- Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Muayad Shaban
- Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Gamal Eltagy
- Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
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Sola R, Rosenfeld EH, Yu YR, St Peter SD, Shah SR. Magnet foreign body ingestion: rare occurrence but big consequences. J Pediatr Surg 2018; 53:1815-1819. [PMID: 28899548 DOI: 10.1016/j.jpedsurg.2017.08.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To review the outcomes of magnet ingestions from two children's hospitals and develop a clinical management pathway. METHODS Children <18years old who ingested a magnet were reviewed from 1/2011 to 6/2016 from two tertiary center children's hospitals. Demographics, symptoms, management and outcomes were analyzed. RESULTS From 2011 to 2016, there were 89 magnet ingestions (50 from hospital 1 and 39 from hospital 2); 50 (56%) were males. Median age was 7.9 (4.0-12.0) years; 60 (67%) presented with multiple magnets or a magnet and a second metallic co-ingestion. Suspected locations found on imaging were: stomach (53%), small bowel (38%), colon (23%) and esophagus (3%). Only 35 patients (39%) presented with symptoms and the most common symptom was abdominal pain (33%). 42 (47%) patients underwent an intervention, in which 20 (23%) had an abdominal operation. For those undergoing abdominal surgery, an exact logistic regression model identified multiple magnets or a magnet and a second metallic object co-ingestion (OR 12.9; 95% CI, 2.4 - Infinity) and abdominal pain (OR 13.0; 95% CI, 3.2-67.8) as independent risk factors. CONCLUSION Magnets have a high risk of requiring surgical intervention for removal. Therefore, we developed a management algorithm for magnet ingestion. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Richard Sola
- The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO, USA.
| | - Eric H Rosenfeld
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
| | - Yangyang R Yu
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
| | - Shawn D St Peter
- The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO, USA.
| | - Sohail R Shah
- Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
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Surd A, Aldea C, Mironescu A, Gocan H. Transmesocolic double gastro-enteric fistulas due to ingestion of 28 magnets. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Background Although foreign bodies (FBs) typically pass spontaneously and uneventfully through the digestive tract, a subset of such bodies may become trapped, eventually leading to significant injury. In particular, the ingestion of magnetic materials can cause serious morbidity due to proximate attraction through the intestinal wall. Case presentation We recently treated three pediatric patients who had ingested several magnetic foreign materials. None of these patients exhibited any clinical symptoms or signs suggestive of surgical abdomen. Moreover, it was difficult to determine a definite diagnosis and a treatment plan due to limitations in history taking and radiologic examination. After admission to the hospital, these patients underwent surgery for the following reasons: (1) failure to spontaneously pass ingested foreign materials; (2) sudden-onset abdominal pain and vomiting during hospitalization; and (3) gastric perforation incidentally discovered during gastroduodenoscopy. Subsequently, all patients were discharged without complications; however, their conditions might have been fatal without surgery at an appropriate time. Conclusions As the clear identification about the number and characteristics of ingested magnets via radiographic examination or patient history appears to be difficult in pediatric patients, close inpatient observation would be required in any case of undetermined metallic FB ingestion. Patients who are confirmed to have ingested multiple magnets should be regarded as conditional surgical patients, although their clinical conditions are stable.
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Affiliation(s)
- Jinbeom Cho
- Department of Surgery, The Catholic University of Korea, College of Medicine, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kiyoung Sung
- Department of Surgery, The Catholic University of Korea, College of Medicine, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dosang Lee
- Department of Surgery, The Catholic University of Korea, College of Medicine, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. .,Department of Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, Uijeongbu-si, 11765, Republic of Korea.
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Sekmenli T, Ciftci I. Multiple Intestinal Perforation and Necrosis due to Magnet Ingestion. Eurasian J Med 2016; 48:225-227. [PMID: 28149151 DOI: 10.5152/eurasianjmed.2015.0080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/29/2015] [Indexed: 11/22/2022] Open
Abstract
Among the few foreign bodies swallowed, multiple magnets are very rare. Ingestion of Multiple Magnets may lead to a number of dire complications. The present case report is about the ingestion of multiple singing magnets by 4-year-old child leading to intestinal segmental necrosis and perforations.
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Affiliation(s)
- Tamer Sekmenli
- Department of Pediatric Surgery, Selcuk University School of Medicine, Konya, Turkey
| | - Ilhan Ciftci
- Department of Pediatric Surgery, Selcuk University School of Medicine, Konya, Turkey
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Lee YZ, Chia CLK, Chanyaputhipong J, Lim EKW. Fashion misadventure: small bowel perforation caused by magnetic tongue studs usage. ANZ J Surg 2015; 88:E355-E356. [PMID: 26573994 DOI: 10.1111/ans.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yao Zong Lee
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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Olczak M, Skrzypek E. A case of child death caused by intestinal volvulus following magnetic toy ingestion. Leg Med (Tokyo) 2015; 17:184-7. [DOI: 10.1016/j.legalmed.2014.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/13/2014] [Accepted: 11/26/2014] [Indexed: 12/19/2022]
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Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2015; 60:562-74. [PMID: 25611037 DOI: 10.1097/mpg.0000000000000729] [Citation(s) in RCA: 314] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Foreign body ingestions in children are some of the most challenging clinical scenarios facing pediatric gastroenterologists. Determining the indications and timing for intervention requires assessment of patient size, type of object ingested, location, clinical symptoms, time since ingestion, and myriad other factors. Often the easiest and least anxiety-producing decision is the one to proceed to endoscopic removal, instead of observation alone. Because of variability in pediatric patient size, there are less firm guidelines available to determine which type of object will safely pass, as opposed to the clearer guidelines in the adult population. In addition, the imprecise nature of the histories often leaves the clinician to question the timing and nature of the ingestion. Furthermore, changes in the types of ingestions encountered, specifically button batteries and high-powered magnet ingestions, create an even greater potential for severe morbidity and mortality among children. As a result, clinical guidelines regarding management of these ingestions in children remain varied and sporadic, with little in the way of prospective data to guide their development. An expert panel of pediatric endoscopists was convened and produced the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body ingestions. This guideline is intended as an educational tool that may help inform pediatric endoscopists in managing foreign body ingestions in children. Medical decision making, however, remains a complex process requiring integration of clinical data beyond the scope of these guidelines. These guidelines should therefore not be considered to be a rule or to be establishing a legal standard of care. Caregivers may well choose a course of action outside of those represented in these guidelines because of specific patient circumstances. Furthermore, additional clinical studies may be necessary to clarify aspects based on expert opinion instead of published data. Thus, these guidelines may be revised as needed to account for new data, changes in clinical practice, or availability of new technology.
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Ingestion de corps étrangers aimantés chez l’enfant : enquête multicentrique française. Arch Pediatr 2015; 22:32-8. [DOI: 10.1016/j.arcped.2014.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/08/2014] [Accepted: 10/17/2014] [Indexed: 12/16/2022]
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Jang SI, Choi J, Lee DK. Magnetic compression anastomosis for treatment of benign biliary stricture. Dig Endosc 2015; 27:239-49. [PMID: 24905938 DOI: 10.1111/den.12319] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/30/2014] [Indexed: 12/13/2022]
Abstract
Endoscopic and percutaneous procedures have shown high success rates when used to treat benign biliary stricture. However, cases in which a guidewire cannot be passed through a refractory stricture or a complete obstruction are difficult to treat using conventional methods. Magnetic compression anastomosis (MCA) has emerged as a non-surgical alternative avoiding operational mortality and morbidity. The feasibility and safety of MCA have been experimentally and clinically verified in cases of biliobiliary and bilioenteric anastomosis. However, no pre-MCA assessment modality capable of predicting outcomes is as yet available, and no universally effective magnet delivery method has as yet been established, rendering it difficult to identify patients for whom MCA is appropriate. Various experimental studies seeking to overcome these limitations are underway. Such work will improve our in-depth understanding of MCA, which has been trialed in various fields. Upon further development, MCA may become a ground-breaking option for treatment of benign strictures that are difficult to resolve using conventional methods, and MCA may be expected to be minimally traumatic and highly effective. The aim of the present study was to discuss the current status of MCA and the direction of MCA development by reviewing clinical and experimental MCA data.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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George AT, Motiwale S. Revisiting the algorithm: are we causing more confusion? J Emerg Med 2014; 46:e95. [PMID: 24238598 DOI: 10.1016/j.jemermed.2013.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/24/2013] [Indexed: 06/02/2023]
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Abstract
Although most ingested foreign bodies in children pass spontaneously, certain foreign bodies can be harmful and they require special attention and emergent medical intervention to prevent significant morbidity and mortality. This article presents an overview of the epidemiology, diagnosis, management, and complications of foreign body ingestions in children. Particular attention is paid to coins, sharp objects, long objects, food bolus, caustic liquids, batteries, and magnets.
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Affiliation(s)
- Christian C Wright
- Division of Emergency Medicine, Department of Pediatrics, University of Maryland School of Medicine, University of Maryland Children's Hospital, 22 South Greene Street, Baltimore, MD 21201, USA.
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Savage J, Clarnette T, King SK. Toy magnet ingestion and small bowel obstruction: a lesson for both paediatricians and surgeons. J Paediatr Child Health 2013; 49:E461-2. [PMID: 24028524 DOI: 10.1111/jpc.12174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Jason Savage
- Department of Paediatric Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
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Adikibi BT, Arnold M, van Niekerk G, Alexander A, Numanoglu A, Millar AJW. Magnetic bead toy ingestion: uses and disuses in children. Pediatr Surg Int 2013; 29:741-4. [PMID: 23411613 DOI: 10.1007/s00383-013-3275-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 12/25/2022]
Abstract
A 2-year-old female presented acutely with peritonitis and small bowel obstruction. An abdominal radiograph demonstrated a radiopaque foreign body. At laparotomy she was found to have bowel perforations with entero-enteric fistulae caused by four magnets. The magnets were removed, and debridement and closure of the perforations performed. We review our case and highlight this problem to other medical practitioners as a potential cause of significant morbidity and mortality in the paediatric population.
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Affiliation(s)
- Boma T Adikibi
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town 7700, South Africa.
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Macedo M, Velhote MCP, Maschietto RF, Waksman RD. Intestinal fistula after magnets ingestion. EINSTEIN-SAO PAULO 2013; 11:234-6. [PMID: 23843068 PMCID: PMC4872901 DOI: 10.1590/s1679-45082013000200018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 02/22/2013] [Indexed: 11/22/2022] Open
Abstract
Accidental ingestion of magnetic foreign bodies has become more common due to increased availability of objects and toys with magnetic elements. The majority of them traverse the gastrointestinal system spontaneously without complication. However, ingestion of multiple magnets may require surgical resolution. The case of an 18-month girl who developed an intestinal fistula after ingestion of two magnets is reported.
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George AT, Motiwale S. Magnets, children and the bowel: A dangerous attraction? World J Gastroenterol 2012; 18:5324-8. [PMID: 23082048 PMCID: PMC3471100 DOI: 10.3748/wjg.v18.i38.5324] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 08/13/2012] [Accepted: 08/16/2012] [Indexed: 02/06/2023] Open
Abstract
Reports of magnet ingestion are increasing rapidly globally. However, multiple magnet ingestion, the subsequent potential complications and the importance of the early identification and proper management remain both under-recognized and underestimated. Published literature on such cases could possibly represent only the tip of an iceberg with press reports, web blogs and government documents highlighting further occurrence of many more such incidents. The increasing number of complications worldwide being reported secondary to magnet ingestion point not only to an acute lack of awareness about this condition among the medical profession but also among parents and carers who will be in most cases the first to pick up on magnet ingestion. There still seems to be no consensus on the management of magnet ingestion with several algorithms being proposed for management. Prevention of this condition remains a much better option than cure. Proper education and improved awareness among parents and carers and frontline medical staff is key in addressing this rapidly emerging problem. The goal of managing such cases of suspected magnet ingestion should be aimed at reducing delays between ingestion time, diagnosis time and intervention time.
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Abstract
We describe a comprehensive algorithm for the management of ingested rare-earth magnets in children. These newer and smaller neodymium magnets sold as adult toys are much stronger than the traditional magnets, and can attract each other with formidable forces. If >1 magnet is swallowed at the same time, or a magnet is co-ingested with another metallic object, the loops of intestine can be squeezed between them resulting in bowel damage including perforations. An algorithm that uses the number of magnets ingested, location of magnets, and the timing of ingestion before intervention helps to delineate the roles of the pediatric gastroenterologists and surgeons in the management of these cases.
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Prevalence, clinical features and management of pediatric magnetic foreign body ingestions. J Emerg Med 2012; 44:261-8. [PMID: 22727803 DOI: 10.1016/j.jemermed.2012.03.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/31/2012] [Accepted: 03/28/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Foreign body (FB) ingestions are frequent in children. Whereas the majority of FBs pass spontaneously through the gastrointestinal tract, ingestion of magnetic FBs pose a particular risk for obstruction due to proximate attraction through the intestinal wall. STUDY OBJECTIVES We aimed to identify the prevalence, clinical presentation, and management of magnetic FB ingestions at our tertiary care institution. METHODS We performed a retrospective chart review of medical records of patients presenting to the pediatric Emergency Department (ED) or admitted to the hospital with FB ingestions from June 2003-July 2009. From those cases, patients with magnetic FB ingestions were identified. RESULTS During the study period, 337,839 patients presented to the ED; 38 cases of magnetic FB ingestion were identified (prevalence 0.01%). Abdominal radiography was obtained in all cases. Ingestion of a single magnet occurred in 30 of 38 cases (79%). Of those, 4 patients underwent endoscopic removal due to signs of FB impaction in the esophagus or pylorus; no complications were noted. Ingestion of multiple magnets (range 2-6) occurred in 8 of 38 cases. Four of the 8 patients with multiple magnetic FBs (50%) presented with signs of peritonitis and required operative repair of multiple intestinal perforations. No deaths were identified. CONCLUSION Although ingestion of a single magnetic FB may, in most cases, be managed as a simple FB ingestion, the ingestion of multiple magnetic FB is associated with a high risk of complication and requires aggressive management. We propose an algorithm for management of children with magnetic FB ingestions.
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Martínez Criado Y, Tuduri Limousín I, Maraví A, de Agustín Asensio J. Ingesta seriada de imanes en niños: importancia de su identificación precoz. An Pediatr (Barc) 2012; 76:374-6. [DOI: 10.1016/j.anpedi.2012.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/03/2012] [Accepted: 01/24/2012] [Indexed: 10/28/2022] Open
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Oh HK, Ha HK, Shin R, Ryoo SB, Choe EK, Park KJ. Jejuno-jejunal fistula induced by magnetic necklace ingestion. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:394-6. [PMID: 22708104 PMCID: PMC3373992 DOI: 10.4174/jkss.2012.82.6.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 01/03/2012] [Accepted: 01/19/2012] [Indexed: 12/21/2022]
Abstract
We describe the case of a 19-year-old mentally challenged woman who developed jejuno-jejunal fistula following ingestion of a magnetic necklace. This case report demonstrates the necessity of prompt treatment when the ingested intestinal foreign body is suspected to be multiple magnets, even if there are no sharp edges; and even when it seems the object could be evacuated spontaneously. Ingested magnets are capable of attracting each other across the bowel wall, leading to serious intestinal complications such as pressure necrosis, perforation, fistula formation, or intestinal obstruction.
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Affiliation(s)
- Heung-Kwon Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
RATIONALE AND AIM Among foreign bodies causing injuries in children, magnets have been reported to cause serious complications and being life-threatening. The aim of this study is to design a risk profile and an epidemiological figure of such injuries, for being used for prevention. METHODS Data on 366 injuries have been collected from public surveillance databases and from published scientific literature, and compared with the data of the Susy Safe registry, which is a pan-European registry of foreign bodies injuries co-funded by the European Commission. RESULTS A median age of 48 months was observed, with a 63% prevalence of males is characterizing the injuries. Magnets have a median volume of 87.9 mm(3) vs the median volume of 41.86 mm(3) of the overall foreign bodies of the Susy Safe registry). Only 43% of the magnets were involving only on piece or objects, with a median number of two objects per injury, up to a maximum of 32 objects. Children are referred to the medical care system with a median delay of 3 days after onset of symptoms. Median length of stay in the hospital was 7 days with respect to 1 day as in the Susy Safe registry. CONCLUSION Most of complications, and event the death of a child can be eventually re-conducted to either or both a delay in patient referral or appropriate diagnosis. Thus, it is an absolute priority that an information initiative is taken toward families and emergency doctors to avoid unnecessarily delays respectively in patient referral and in diagnosis.
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Affiliation(s)
- Dario Gregori
- Laboratory of Epidemiological Methods and Biostatistics, Department of Environmental Medicine and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy.
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Naji H, Isacson D, Svensson JF, Wester T. Bowel injuries caused by ingestion of multiple magnets in children: a growing hazard. Pediatr Surg Int 2012; 28:367-74. [PMID: 22127484 DOI: 10.1007/s00383-011-3026-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE There are no definite guidelines on the management of ingested magnetic objects in children. The aim of this study was to present our experience and to highlight the importance of strict follow-up. METHODS Within 6 months period, four children presented to the emergency department after ingestion of multiple magnets. We reviewed retrospectively the patients' documents, radiological reports, operative findings and outcome. We also performed a literature search for all reports of multiple magnets ingestion on MEDLINE and EMBASE. RESULTS Daily abdominal radiographs to monitor migration of magnetic objects together with clinical examination revealed early detection of perforations in two patients. Explorative laparoscopy and suturing of perforations resulted in a rapid recovery and good cosmetic appearance. Literature search resulted in 44 published articles with a total of 52 cases of multiple magnet ingestion in children. CONCLUSIONS This report stresses the need for prompt follow-up and early detection of complications in order to operate those patients without delay. Laparoscopy is the method of choice in exploring the abdomen when perforation is suspected.
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Affiliation(s)
- Hussein Naji
- Astrid Lindgren Children's Hospital, Karolinska University, Stockholm, Solna, Sweden.
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Sutureless Intestinal Anastomosis with a Novel Device of Magnetic Compression Anastomosis. ACTA ACUST UNITED AC 2011; 26:182-9. [DOI: 10.1016/s1001-9294(11)60046-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Smart Self-Assembling MagnetS for ENdoscopy (SAMSEN) for transoral endoscopic creation of immediate gastrojejunostomy (with video). Gastrointest Endosc 2011; 73:353-9. [PMID: 21183179 DOI: 10.1016/j.gie.2010.10.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 10/13/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrojejunostomy is important for palliation of malignant gastric outlet obstruction and surgical obesity procedures. A less-invasive endoscopic technique for gastrojejunostomy creation is conceptually attractive. Our group has developed a compression anastomosis technology based on endoscopically delivered self-assembling magnets for endoscopy (SAMSEN) to create an instant, large-caliber gastrojejunostomy. OBJECTIVE To develop and evaluate an endoscopic means of gastrojejunostomy creation by using SAMSEN. SETTING Developmental laboratory and animal facility. DESIGN Animal study and human cadaveric study. SUBJECTS Yorkshire pigs (7 cadaver, 5 acute); human (1 cadaver). INTERVENTIONS A transoral procedure for SAMSEN delivery was developed in porcine and human cadaver models. Subsequently, gastrojejunostomy creation by using SAMSEN was performed in 5 acute pigs. The endoscope was advanced into the peritoneal cavity through the gastrotomy, and a segment of the small bowel was grasped and pulled closer to the stomach. An enterotomy was created, and a custom overtube was advanced into the small bowel for deployment of the first magnetic assembly. Next, a reciprocal magnetic assembly was deployed in the stomach. The 2 magnetic systems were mated under fluoroscopic and endoscopic guidance. Contrast studies assessed for gastrojejunostomy leak. Immediate necropsies were performed. MAIN OUTCOME MEASUREMENTS Technical feasibility and complications. RESULTS Gastrojejunostomy creation by using SAMSEN was successful in all 5 animals. Deep enteroscopy was performed through the stoma without difficulty. No leaks were identified on contrast evaluation. At necropsy, the magnets were properly deployed and robustly coupled together, resistant to vigorous tissue manipulation. LIMITATIONS Acute animal study. CONCLUSIONS Endoscopic creation of immediate gastrojejunostomy by using SAMSEN is technically feasible.
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A rare cause of intestinal perforation: ingestion of magnet. World J Pediatr 2010; 6:369-71. [PMID: 21080149 DOI: 10.1007/s12519-010-0237-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 01/15/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ingestion of foreign objects is a common problem in children. Ingestion of one more magnets may require surgical intervention because of risk of perforation. METHODS A 4-year-old girl was admitted to our department with complaints of abdominal pain and bilious vomiting. She had been treated at another clinic with repeated abdominal X-rays because of ingestion of a magnet 5 days ago. Physical examination revealed diffuse abdominal tenderness and bilious drainage from the nasogastric tube. The magnet was observed by radiopaque imaging in the right epigastric region of the upright abdomen but there was no free air. The magnet was presumed to be in the duodenum and exploratory laparotomy was performed. RESULTS During the operation, a perforation was found between the pylorus and duodenum due to the magnet. The foreign body was found to be two magnets adherent to each; the interposed and compressed tissue was necrotized and perforated between the two magnets. The necrotized segment was excised and primary anastomosis was made. The postoperative period of the patient was uneventful and she was discharged on the seventh postoperative day. CONCLUSIONS Ingestion of foreign objects such as one more magnets may cause intestinal perforation in early stages. If the object stays in the same location shown by repeated X-rays, surgical intervention should not be delayed.
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Kiefer K, Hottinger H, Kahn T, Ngo M, Ben-Amotz R. Magnet ingestion in dogs: two cases. J Am Anim Hosp Assoc 2010; 46:181-5. [PMID: 20439941 DOI: 10.5326/0460181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Two dogs that had ingested foreign bodies were presented with vomiting. The foreign bodies appeared as metal and dense on abdominal radiographs. Abdominal exploratory identified intestinal perforation in one case and gastrointestinal tissue trapped between the two foreign bodies adhered to each other in the second case. The foreign bodies were identified as magnets in one case and magnets and other metallic foreign bodies in the second case. Both dogs had excellent outcomes following surgical intervention. These cases demonstrate the danger of tissue entrapment between the foreign bodies as a result of the magnetic attraction between two objects. Dogs that are presented with a history of or are suspect for ingesting multiple magnets or a magnet and metal foreign bodies should be treated with surgical intervention because of the risk of gastrointestinal perforation as a result of magnetic attraction between the foreign bodies.
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Affiliation(s)
- Kristina Kiefer
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1352 Boyd Avenue, St. Paul, Minnesota 55108, USA
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Saeed A, Johal NS, Aslam A, Brain J, Fitzgerald RJ. Attraction problems following magnet ingestion. Ann R Coll Surg Engl 2009; 91:W10-2. [PMID: 19622254 DOI: 10.1308/147870809x450566] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Atif Saeed
- Department of Paediatric Surgery, Addenbrooke's Hospital, Cambridge, UK.
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38
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Oestreich AE. Worldwide survey of damage from swallowing multiple magnets. Pediatr Radiol 2009; 39:142-7. [PMID: 19020871 DOI: 10.1007/s00247-008-1059-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 09/16/2008] [Accepted: 10/17/2008] [Indexed: 12/21/2022]
Abstract
BACKGROUND It is increasingly recognized that in children swallowed multiple magnets cause considerable damage to the gastrointestinal tract. OBJECTIVE To emphasize that complications from swallowed magnets are extensive worldwide and throughout childhood. MATERIALS AND METHODS The author surveyed radiologists and researched cases of magnet swallowing in the literature and documented age and gender, numbers of magnets, nature of the magnets, reasons for swallowing, and clinical course. RESULTS A total of 128 instances of magnet swallowing were identified, one fatal. Cases from 21 countries were found. Magnet swallowing occurred throughout childhood, with most children older than 3 years of age. Numbers of swallowed magnets ranged up to 100. Twelve children were known to be autistic. Many reasons were given for swallowing magnets, and a wide range of gastrointestinal damage was encountered. Considerable delay before seeking medical assistance was frequent, as was delay before obtaining radiographs or US imaging. CONCLUSION Damage from swallowing multiple magnets is a considerable worldwide problem. More educational and preventative measures are needed.
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Affiliation(s)
- Alan E Oestreich
- Radiology Department 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.
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Jamshidi R, Stephenson JT, Clay JG, Pichakron KO, Harrison MR. Magnamosis: magnetic compression anastomosis with comparison to suture and staple techniques. J Pediatr Surg 2009; 44:222-8. [PMID: 19159747 DOI: 10.1016/j.jpedsurg.2008.10.044] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Accepted: 10/07/2008] [Indexed: 12/11/2022]
Abstract
PURPOSE An ideal anastomosis between hollow viscera should be easily performed, strong, and operator independent. We hypothesized that transluminal attraction between magnets in the intestine could be harnessed to create an intestinal compression anastomosis (magnamosis) with these characteristics. We further hypothesized that variation of attraction force and geometry of compression would affect the quality of the intestinal anastomosis. METHODS We designed a self-orienting device composed of 2 neodymium-iron-boron magnets affixed to polytetrafluoroethylene moldings. Two topologies were evaluated: one designed with 'uniform' compression and the other with 'gradient' compression. Sixteen young adult pigs (Sus scrofa) underwent laparotomy with creation of a magnetic side-to-side anastomosis: 8 with the uniform device and 8 with the gradient device. Each also had a stapled anastomosis, and 5 had an additional hand-sutured anastomosis. Animals were euthanized at 1, 2, and 3 weeks after operation, then anastomoses were compared on the basis of gross appearance, histology, functional radiography, and mechanical integrity. RESULTS All magnetic devices formed patent anastomoses without leak. One stapled anastomosis resulted in a contained leak. Mechanical integrity of magnetic anastomoses was not statistically significantly different from staple or suture counterparts, and there was a trend toward greater strength with magnetic anastomoses. Comparison between device types revealed the gradient device trended toward greater strength and earlier patency (67% vs 33% at 1 week). There was no evidence of stenosis, and histologic examination demonstrated tissue remodeling with mucosal and serosal apposition across the magnamoses. CONCLUSIONS The magnetic compression anastomosis (magnamosis) device is a safe and effective means of sutureless full-thickness intestinal anastomosis with serosal apposition in a pig model. Gradient compression is superior to uniform compression. This technique is compatible with endoscopic and natural orifice approaches.
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Affiliation(s)
- Ramin Jamshidi
- Department of Surgery, University of California San Francisco, CA 94143-0570, USA
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Raquillet C, Guérin F, Martelli H, Goldszmidt D, Gauthier F, Wildhaber BE. [Swallowing magnets: a dangerous game. A case report]. Arch Pediatr 2008; 15:1095-8. [PMID: 18434107 DOI: 10.1016/j.arcped.2008.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 01/04/2008] [Accepted: 02/23/2008] [Indexed: 11/17/2022]
Abstract
Complications related to the ingestion of magnetic foreign bodies by children represents an affirmed health hazard in the United States. In France, an alert has been announced. We report the 1st case in France. Our aim is to alert pediatricians and emergency physicians and to draw attention to the particularities of this type of foreign body. Responsible for complications is the ingestion of at least 2 magnets, or 1 magnet and a metallic foreign body, with a time interval between ingestions. In these cases, it is strongly recommended to extract the foreign bodies with endoscopy if they have not yet passed the pylorus. For those further advanced in the intestinal tract, continuous observation is warranted and surgical extraction is indicated on apparition of 1st clinical symptoms.
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Affiliation(s)
- C Raquillet
- Service de chirurgie pédiatrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
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Fenton SJ, Torgenson M, Holsti M, Black RE. Magnetic attraction leading to a small bowel obstruction in a child. Pediatr Surg Int 2007; 23:1245-7. [PMID: 17694401 DOI: 10.1007/s00383-007-1997-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2007] [Indexed: 11/30/2022]
Abstract
Foreign body ingestion in small children is common yet only 1% of cases require operative management of associated complications (Arana et al. in Eur J Pediatr 160:468-472, 2001). A 6-year-old boy was referred to our institution with a 12 h history of abdominal pain. This pain was diffuse and crampy in nature and associated with multiple episodes of non-bilious, non-bloody emesis. On evaluation he was stable and his abdomen demonstrated slight distention and tenderness without peritoneal signs. Plain abdominal radiographs demonstrated some distended loops of small bowel and a radio-opaque foreign object within the mid-abdomen. A small bowel obstruction secondary to foreign body ingestion was diagnosed and an emergent laparotomy performed. Upon exploration, a transition zone was noted near the ileocecal valve. Further exploration revealed the obstruction to be caused secondary to the apposition of two small (8 mm) magnets, one in the proximal ileum and the other near the ileocecal valve, resulting in an internal hernia. The magnets were easily separated relieving the obstruction and both were removed via two small bowel enterotomies. After being presented with the magnets, his parents suspected that they came from the clothes of a Polly Pocket (Mattel, Inc., El Segundo, CA) doll. The patient had an uneventful post-operative course and was discharged to home on the second post-operative day. This case demonstrates the complications that may occur with multiple magnet ingestion. It highlights the need for close observation and early surgical intervention in children with a suspected history of foreign body ingestion, a clinical picture of gastrointestinal distress, and radiographic evidence of a radio-opaque foreign object.
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Affiliation(s)
- Stephen J Fenton
- Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA.
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Abstract
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.
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Abstract
Multiple magnet ingestion is an unexpected health hazard in children that can lead to significant gastrointestinal morbidity. The magnets are attracted to each other across the bowel wall and this may lead to pressure necrosis, resulting in perforation, fistula formation, and/or intestinal obstruction. We report herein a case of small bowel obstruction following ingestion of two magnets. The public and clinicians should be aware of the health hazard of such devices.
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Affiliation(s)
- Abdulrahman M Alzahem
- Department of Academic Surgery, The Children's Hospital at Westmead, Westmead, Australia
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Hernández Anselmi E, Gutiérrez San Román C, Barrios Fontoba JE, Ayuso González L, Valdés Dieguez E, Lluna González J, Roca Molla A, García-Sala Viguer C, Gómez Montes J, Cortina Orts H. Intestinal perforation caused by magnetic toys. J Pediatr Surg 2007; 42:E13-6. [PMID: 17336176 DOI: 10.1016/j.jpedsurg.2006.12.066] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Ilçe Z, Samsum H, Mammadov E, Celayir S. Intestinal Volvulus and Perforation Caused by Multiple Magnet Ingestion: Report of a Case. Surg Today 2007; 37:50-2. [PMID: 17186347 DOI: 10.1007/s00595-006-3330-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Accepted: 06/13/2006] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Zekeriya Ilçe
- Department of Pediatric Surgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
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46
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de la Fuente SG, Rice HE. Ingestion of unusual foreign bodies and malrotation: a "perfect storm". Pediatr Surg Int 2006; 22:869-72. [PMID: 16947024 DOI: 10.1007/s00383-006-1774-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2006] [Indexed: 10/24/2022]
Abstract
Management of foreign body ingestion is usually nonsurgical unless atypical foreign bodies or anatomical variants are suspected. The present article illustrates a case of atypical foreign bodies ingestion in the presence of intestinal malrotation. The patient required surgical treatment and had an uneventful postoperative recovery. The article also reviews the cases reported in the literature of magnetic ingestion and the possible complications associated with it.
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Affiliation(s)
- David A Berg
- Department of Surgery, Temple University Hospital, Philadelphia, PA 19140, USA
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Uchida K, Otake K, Iwata T, Watanabe H, Inoue M, Hatada T, Kusunoki M. Ingestion of multiple magnets: hazardous foreign bodies for children. Pediatr Radiol 2006; 36:263-4. [PMID: 16317540 DOI: 10.1007/s00247-005-0056-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 10/13/2005] [Accepted: 10/18/2005] [Indexed: 10/25/2022]
Abstract
We report a case of perforation, fistula formation, and small bowel obstruction in a 2-year-old child who had ingested 32 small magnets. Multiple magnets will attract one another through the bowel wall and lead to pressure necrosis with complications. We recommend early surgical intervention before the onset of gastrointestinal complications if ingested multiple magnets have not moved on the follow-up radiograph. Both clinicians and the lay population need to be aware that multiple magnets can be hazardous foreign bodies for children.
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Affiliation(s)
- Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie 514-8507, Japan.
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Liu S, de Blacam C, Lim FY, Mattei P, Mamula P. Magnetic foreign body ingestions leading to duodenocolonic fistula. J Pediatr Gastroenterol Nutr 2005; 41:670-2. [PMID: 16254529 DOI: 10.1097/01.mpg.0000177703.99786.c9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Steven Liu
- Division of Gastroenterology and Nutrition, Department of Pediatrics, and the, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Abstract
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.
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Affiliation(s)
- Barbara E Wildhaber
- Pediatric Surgery, University of Children's Hospital, 1211 Geneva, Switzerland.
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