Orogastric magnet removal of ingested disc batteries

Endoscopic retrieval of ingested magnets in children and role of magnetic retrievers

Background

Various high-powered magnetic toy sets constitute a major hazard as the small magnets can be easily swallowed or aspirated by young children. Multiple ingested magnets or the ingestion of a magnet with another metallic object can pose a serious threat as this may lead to bowel perforation, fistulation, intestinal volvulus, bowel obstruction and death.

Main body

Retrieval of ingested magnets from the stomach is routinely performed endoscopically but can become a painstaking quest involving many tedious attempts to secure the magnet(s). Historically, pre-routine endoscopy, magnetic retrievers were used under fluoroscopic control for the removal of metallic objects in the stomach. With the advent of endoscopic retrieval instruments, they fell out of favour and are no longer readily available on the market. Despite this, conventional endoscopic instruments are likely to be less effective than endoscopic-assisted magnetic retrievers due to confounding weak bonds which form between the metal retrieval device and the magnet.

Preoperative testing, and selection of the retrieval instrument with the strongest coupling effect with a magnet, might be beneficial. A simple, endoscopic-assisted magnetic retriever created in theatre can allow for more effective, time-efficient and safe removal of ingested magnets under direct vision.

Conclusion

Urgent removal of multiple ingested magnets or a single ingested magnet coupled with another ingested metallic object should be highlighted. Stricter implementation of a widespread ban over loose magnetic toys is needed. Standardised protocols for the surgical management of ingested magnets should be available in every hospital.

Foreign Body Removal in Children Using Foley Catheter or Magnet Tube from Gastrointestinal Tract

Foreign body (FB) ingestion of children is a common pediatric emergency requiring medical attention. Pediatric emergency physicians and gastroenterologists often encounter nervous and distressed situations, because of children presenting with this condition in the common clinical practice. When determining the appropriate timing and indications for intervention, physicians should consider multiple patient- and FB-related factors. The utilization of a flexible endoscopy is considered safe and effective to use in these cases, with a high success rate, for the effective extraction of FBs from the gastrointestinal tract of a child. Additionally, a Foley catheter and a magnet-attached Levin tube have been used for decades in the case of FB removal. Although their use has decreased significantly in recent times, these instruments continue to be used for several indications. Using a Foley catheter for this purpose does not require special training and does not necessarily require sedation of the patient or fluoroscopy, which serve as advantages of utilizing this method for foreign object retrieval. An ingested magnet or iron-containing FB can be retrieved using a magnet-attached tube, and can be effective to retrieve an object from any section of the upper gastrointestinal tract that can be reached. Simple and inexpensive devices such as Foley catheters and magnet-attached tubes can be used in emergencies such as with the esophageal impaction of disk batteries if endoscopy cannot be performed immediately (e.g., in rural areas and/or in patients presenting at midnight in a facility, especially in those without access to endoscopes or emergency services, or in any situation that warrants urgent removal of a foreign object).

Analysis of 334 Cases of Pediatric Esophageal Foreign Body Removal Suggests that Traditional Methods Have Similar Outcomes Whereas a Magnetic Tip Orogastric Tube Appears to be an Effective, Efficient, and Safe Technique for Disc Battery Removal

Procedures and outcomes for pediatric esophageal foreign body removal were analyzed. Traditional methods of battery removal were compared with a magnetic tip orogastric tube (MtOGT). A single institution retrospective review from 1997 to 2014 of pediatric patients with esophageal foreign bodies was performed. Balloon extraction with fluoroscopy (performed in 173 patients with 91% success), flexible endoscopy (92% success in 102 patients), and rigid esophagoscopy (95% in 38 patients) had excellent success rates. A MtOGT had 100 per cent success in six disc battery patients, when other methods were more likely to fail, and was the fastest. Power analysis suggested 20 patients in the MtOGT group would be needed for significant savings in procedural time. Thirty-two per cent of all foreign bodies and 95 per cent of batteries had complications (P = 0.002) because of the foreign body. Overall, 1.2 per cent had severe complications, whereas 10 per cent of batteries had severe complications (P = 0.04). Each technique if applied appropriately can be a reasonable option for esophageal foreign body removal. Magnetic tip orogastric tubes used to extract ferromagnetic objects like disc batteries had the shortest procedure time and highest success rate although it was not statistically significant. Disc batteries require emergent removal and have a significant complication rate.

Accidental button battery ingestion presenting as croup

OBJECTIVES

To report a case of misdiagnosis of an impacted oesophageal button battery in a child, and to describe the associated risk factors for impaction and the management of such cases.

CASE REPORT

An 18-month-old, otherwise fit and well child with stridulous respiration was initially treated for croup. Medical treatment over the course of three months failed, and appropriate imaging subsequently demonstrated an impacted button battery in the upper oesophagus. This was promptly removed. There were no signs of damage on direct visualisation, or on a follow-up contrast swallow image.

CONCLUSION

This case highlights the difficulty of diagnosing oesophageal foreign bodies. We also discuss the characteristics of button batteries which confer a greater risk of impaction, and the associated sequelae and complications.

Ingested button battery retrieved by a modified magnet endoscope

Ingestion of button battery (BB) by toddlers has been seen with increasing frequency over the past decade. Significant morbidity may develop if the ingested BB cannot be removed in time. Herein, we describe 2 infants whose ingested BBs were smoothly and successfully retrieved, from a stenotic esophagus and stomach, by the use of a self-made modified magnet endoscope.

Severe esophageal damage due to button battery ingestion: can it be prevented?

Batteries represent less than 2% of foreign bodies ingested by children, but in the last 2 decades, the frequency has continuously increased. Most ingestions have an uneventful course, but those that lodge in the esophagus can lead to serious complications and even death. Medline was used to search the English medical literature, combining "button battery" and "esophageal burn" as keywords. Cases were studied for type, size, and source of the batteries; duration and location of the battery impaction in the esophagus; symptoms; damage caused by the battery; and outcome. Nineteen cases of esophageal damage have been reported since 1979. Batteries less than 15 mm in diameter almost never lodged in the esophagus. Only 3% of button batteries were larger than 20 mm but were responsible for the severe esophageal injuries in this series. These data suggest that manufacturers should replace large batteries with smaller ones and thus eliminate most of the complications. When the battery remains in the esophagus, endoscopic examination and removal done urgently will allow assessment of the esophageal damage, and treatment can be tailored accordingly. There is a need for more public education about the dangers of battery ingestion; this information should be included as part of the routine guidelines for childproofing the home.

Magnetic removal of a nasal foreign body

We describe a case of metallic nasal foreign body removal from a child with the aid of a permanent magnet. This is the first documented case of such a technique as far as we are aware. Magnets may prove invaluable in the removal of metallic nasal foreign bodies particularly in children and avoid the need for a general anaesthetic. A brief review of the use of magnets to remove foreign bodies is included.

Button battery ingestion: hazards of esophageal impaction

Ingestion of button batteries has been seen with increasing frequency over the past decade. In a small number of reported cases, their impaction in the esophagus has led to serious, sometimes fatal, complications. The management of these cases has varied from expectant, supportive therapy to early surgical intervention. The authors report 2 pediatric patients in whom esophageal perforation developed after impaction of a disc battery. Both were treated conservatively with successful outcomes.