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Özcan R, Hakalmaz AE, Uçar AK, Beser Ö, Emre Ş. Chronic jejuno-colonic fistula and intestinal malabsorption due to multiple magnet ingestions: A case report and systematic review. ULUS TRAVMA ACIL CER 2024; 30:361-369. [PMID: 38738679 PMCID: PMC11154068 DOI: 10.14744/tjtes.2024.50845] [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] [Received: 04/16/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.
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Affiliation(s)
- Rahşan Özcan
- Department of Pediatric Surgery, İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, İstanbul-Türkiye
| | - Ali Ekber Hakalmaz
- Department of Pediatric Surgery, İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, İstanbul-Türkiye
| | - Ayşe Kalyoncu Uçar
- Department of Radiology, İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, İstanbul-Türkiye
| | - Ömer Beser
- Department of Pediatric Gastroenterology, İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Hepatology and Nutrition, İstanbul-Türkiye
| | - Şenol Emre
- Department of Pediatric Surgery, İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, İstanbul-Türkiye
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Hayward RK, Saxena AK. Surgical management of pediatric multiple magnet ingestions in the past two decades of minimal access surgery- systematic review of operative approaches. Updates Surg 2024:10.1007/s13304-023-01750-x. [PMID: 38310610 DOI: 10.1007/s13304-023-01750-x] [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: 11/12/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Multiple magnet ingestion is increasingly reported in paediatrics and can cause significant morbidity. Various surgical approaches exist, though minimal literature compares outcomes between techniques. This review evaluates laparoscopic, laparoscopic-assisted, and open surgery with regard to outcomes. METHOD Systematic review across MEDLINE, Embase, Scopus, and Web of Science identified reports of paediatric multiple magnet ingestion managed surgically between 2002 and 2022. RESULTS Ninety-nine studies were included, reporting data from 136 cases. Of these, 82 (60%) underwent laparotomy, 43 (32%) laparoscopic surgery, and 11 (8%) laparoscopic-assisted procedures. Sixteen laparoscopic cases were converted to open, often due to intraoperative findings including necrosis/perforation, or grossly dilated bowel. Bowel perforation occurred in 108 (79%); 47 (35%) required bowel resection, and 3 had temporary stoma formation. Postoperative recovery was uneventful in 118 (86%). Complications were reported following 15 (18%) open and 3 (7%) laparoscopic surgeries. No complications occurred following laparoscopic-assisted surgery. All post-laparoscopic complications were Clavien-Dindo (CD) Grade I. Following open surgery, 5 complications were CD grade I, 6 were CD grade II, and 4 were CD grade IIIb, requiring re-laparotomy. Median length of stay for open and laparoscopic-assisted procedures was 7 days, and for laparoscopic was 5 days (p < 0.001). CONCLUSION Surgical management of multiple magnet ingestion often achieved uncomplicated recovery and no long-term sequelae. Whilst open laparotomy was the more common approach, laparoscopic surgery was associated with reduced length of stay and postoperative complications. Therefore, in experienced hands, laparoscopic surgery should be considered first-line, with the possibility of conversion to open if required.
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Affiliation(s)
- Romilly K Hayward
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK
| | - Amulya K Saxena
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.
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Ali AA, Dhungana A, Mohamed MKS, Zaadhee A, Rasheed R, Ubaid A, Lee XL, Hayati F, Abd Karim K, Zakaria AD. Magnetic perforation: Why we say NO to kids. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2022.102491] [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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Afzal M, Almakki AA, Abugrain HH, Alsaeed MM, Alzahir BS, Sulis NA. Laparoscopic assisted extraction of multiple ingested magnets leading to entero-enteric fistulae- Case report of three patients. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stephenson SG, Knight CT, Rana HN, Standley T, Figarola S. An Unfortunate Union: A Case of Multiple Magnet Ingestion in a Pediatric Patient. Cureus 2022; 14:e21490. [PMID: 35223268 PMCID: PMC8859820 DOI: 10.7759/cureus.21490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Magnets are among the most dangerous foreign objects that a child can ingest. If more than one magnet is ingested, the attraction between loops of the bowel can bring adjacent loops closer together, leading to perforation, obstruction, or fistulization. Pediatric magnet ingestion patients often require endoscopic or surgical intervention to retrieve the objects and repair the damage created by the magnets. Due to the risks of surgical intervention, management is done with strict adherence to the rare earth magnet ingestion algorithm. We highlighted a pediatric case of multiple magnet ingestion, and the steps that were taken to manage the patient. Our case highlights the potential for complications and the importance of adherence to the management algorithm in these patients. Epidemiology, mechanisms, algorithms, and outcomes for pediatric magnet ingestion patients were discussed.
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Al-Saied G, Alsamahy O, Ibrahim M, Al-Malki T, BenMalek R, Khemakhem R, AlNefaie Z, Hussain T, Shafik Y, Thabet R, Farhan G, Gamal A, Habib SA, Gamal A, Elghazeery M. Enteroenteric fistulae after ingestion of multiple magnets in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102090] [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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Middelberg LK, Funk AR, Hays HL, McKenzie LB, Rudolph B, Spiller HA. Magnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019. J Pediatr 2021; 232:251-256.e2. [PMID: 33516676 DOI: 10.1016/j.jpeds.2021.01.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine, using the National Poison Data System (the data warehouse for poison control centers in the US), magnet foreign body injuries in pediatric patients. We sought to report demographic data, outcome data, and case trends between 2008 and 2019. STUDY DESIGN We conducted a retrospective analysis of the National Poison Data System for patients younger than 19 years of age with a magnet "exposure," which poison centers define as an ingestion, inhalation, injection, or dermal exposure to a poison. RESULTS A total of 5738 magnet exposures were identified. Most were male (3169; 55%), <6 years old (3572; 62%), with an unintentional injury (4828; 84%). There were 222 patients (3.9%) with a confirmed medical "effect," defined as signs, symptoms, and clinical findings not including therapeutic interventions (eg, endoscopy). There was a 33% decrease in cases from 418 (2008-2011) to 281 per year (2012-2017) after high-powered magnet sets were removed from the market. Calls subsequently increased 444% to 1249 per year (2018-2019) after high-powered magnet sets re-entered the market. Cases from 2018 and 2019 increased across all age groups and account for 39% of magnet cases since 2008. CONCLUSIONS Significant increases in magnet injuries correspond to time periods in which high-powered magnet sets were sold, including a 444% increase since 2018. These results reflect the increased need for preventative or legislative efforts.
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Affiliation(s)
- Leah K Middelberg
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH.
| | - Alexandra R Funk
- Nationwide Children's Hospital, Columbus, OH; Central Ohio Poison Center, Columbus, OH
| | - Hannah L Hays
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Central Ohio Poison Center, Columbus, OH
| | - Lara B McKenzie
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH; Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH
| | - Bryan Rudolph
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Henry A Spiller
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Central Ohio Poison Center, Columbus, OH
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Miyamoto R, Okuda M, Kikuchi S, Iwayama H, Hataya H, Okumura A. A nationwide questionnaire survey on accidental magnet ingestion in children in Japan. Acta Paediatr 2021; 110:314-325. [PMID: 32568410 DOI: 10.1111/apa.15428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/15/2020] [Accepted: 06/15/2020] [Indexed: 01/07/2023]
Abstract
AIM The aim is to investigate the actual situation of accidental ingestion of magnets in children in Japan and the clinical features of the resulting gastrointestinal damage. METHODS We developed a questionnaire and sent it to 496 board-certified training hospitals nationwide. Information was collected on the number of children with accidental magnet intake from 2015 to 2017, witnesses of magnet intake, number and type of magnets, presence or absence of gastrointestinal injury, treatment, etc RESULTS: The number of cases of accidental ingestion of magnets within the study period was 104, with a median age of 2 years. About half of the incidents were unwitnessed. There were 33 cases of accidental ingestion of multiple magnets. Among them, oesophagogastroduodenoscopy was performed in 4 children and surgery in 10, and significantly invasive treatment was required in comparison with single-magnet ingestion. Gastrointestinal injury was observed in 11 cases, 10 of which were caused by multiple-magnet ingestion. All 10 of these patients underwent surgical treatment. There was no mortality. CONCLUSION The incidence of accidental magnet ingestion in Japan is estimated to be 50-70 per year. Unwitnessed cases are not uncommon. Multiple magnet ingestion often causes gastrointestinal injury. Many cases of gastrointestinal injury are caused by ingestion of magnetic toys.
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Affiliation(s)
- Ryosuke Miyamoto
- Department of Pediatrics Aichi Medical University School of Medicine Nagakute Aichi Japan
| | - Masumi Okuda
- Department of Pediatrics Hyogo College of Medicine Nishinomiya Hyogo Japan
| | - Shogo Kikuchi
- Department of Public Health Aichi Medical University School of Medicine Nagakute Aichi Japan
| | - Hideyuki Iwayama
- Department of Pediatrics Aichi Medical University School of Medicine Nagakute Aichi Japan
| | - Hiroshi Hataya
- Department of General Pediatrics Tokyo Metropolitan Children's Medical Center Fuchu Tokyo Japan
| | - Akihisa Okumura
- Department of Pediatrics Aichi Medical University School of Medicine Nagakute Aichi Japan
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Magnet ingestion by children: A retrospective study in a medical center in Taiwan. Pediatr Neonatol 2020; 61:542-547. [PMID: 32682694 DOI: 10.1016/j.pedneo.2020.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 04/22/2020] [Accepted: 06/09/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The ingestion of multiple magnets may lead to severe complications including bowel obstruction, perforation, fistula, peritonitis, short bowel syndrome, life-threatening injuries, and even death. The annual case number of high-powered neodymium magnets ingestion has been increasing in the western world and the dearth of available data demonstrates that this issue has been neglected in Taiwan. METHODS We searched the electronic medical records of our institution for patients younger than 18 years old who were diagnosed with, who had ever visited our emergency department, or been hospitalized for magnetic foreign body ingestion between January 2009 and March 2018. Demographic data including the number, shape, and size of magnets ingested, the clinical presentation, type of intervention, and complications were reviewed. RESULTS Thirteen patients who met the enrollment criteria were analyzed. One patient was documented between 2009 and 2013, and twelve were documented between January 2014 and March 2018. Five of the cases documented between 2014 and 2018 had ingested Buckyballs. The median age of the patients was 5 years. All of the patients with clinical symptoms had ingested more than one magnet and required endoscopic or surgical intervention. Bowel perforation or deep ulcer with impending perforation was found in three patients during surgery. CONCLUSION The number of children who visited our emergency department or were hospitalized due to the ingestion of magnets has increased recently. The presence of high power of neodymium magnets in many products increases the risk of ingesting multiple magnets resulting in serious complications. Therefore, stricter policies are needed to prevent children from obtaining products that contain magnets.
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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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Dias DDM, Amorim WWS, Rodriguez JER, Cauduro JF, Pena SP, Dias DS, Dias DI, Dias DL, Lima CSC, Cardoso TM. Bowel obstruction in entero-colic fistula associated with magnet ingestion in children at the Amazonas countryside. AME Case Rep 2019; 3:44. [PMID: 31872179 DOI: 10.21037/acr.2019.09.05] [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: 07/28/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
Ingestion of small objects by children became worrisome as the number of cases increased over the years. Consequences such as intestinal obstruction or even infection of the gastrointestinal tract are becoming more frequent since even in majority cases there is having only an expectant conduct, complications can occur. Also, the combination of two elements such as punctiform metallic materials and imams cause fistula formation in loops with greater ease, granulomas in the intestines, perforation, and can progress to peritonitis or abscesses, as well as having considerable morbidity.
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Affiliation(s)
| | - Wolfram W S Amorim
- General Surgery Service at Getúlio Vargas Teaching Hospital (HUGV), Manaus, Amazonas, Brazil
| | - Juan E R Rodriguez
- Medical School of Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Júlia F Cauduro
- Medical School of Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Samuel P Pena
- Medical School of Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Darlla S Dias
- Nilton Lins University (UNL), Manaus, Amazonas, Brazil
| | - Didney I Dias
- Nilton Lins University (UNL), Manaus, Amazonas, Brazil
| | - David L Dias
- Nilton Lins University (UNL), Manaus, Amazonas, Brazil
| | - Cinira S C Lima
- Pediatric Surgery Service of Institute of Children's Health of Amazonas (ICAM)-Avenina Codajás, Manaus, Amazonas, Brazil
| | - Tiago M Cardoso
- College of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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