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Alansari AN, Baykuziyev T, Soyer T, Akıncı SM, Al Ali KK, Aljneibi A, Alyasi NH, Afzal M, Ksia A. Magnet ingestion in growing children: a multi-center observational study on single and multiple magnet incidents. Sci Rep 2024; 14:4575. [PMID: 38403623 PMCID: PMC10894856 DOI: 10.1038/s41598-024-55127-0] [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: 12/13/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024] Open
Abstract
Over the past 15 years, there has been a noticeable uptick in incidents involving children ingesting multiple magnetic foreign bodies which can cause injuries and gastrointestinal complications including death. The current study aimed to identify the prevalence, clinical presentation, and management of single or multiple magnet ingestions. A retrospective multi-central cross-sectional study was conducted to include all pediatric patients < 18 years presented to the emergency department with ingestion of single or multiple magnets and admitted across hospitals in Qatar, UAE, KSA, Tunisia, and Turkey between January 2011 and December 2021. Demographics, symptoms, management, and outcomes were analyzed. There were 189 magnet ingestions, of which 88 (46.6%) were multiple magnet ingestions. Most patients (55.6%) were male, and the median age was 3.9 (IQR 2-7) years. An abdominal X-ray was obtained in all cases. 119 (62%) patients were conservatively treated, 53 (28%) required surgical intervention and 17 (8.9%) underwent gastroscopy. None of the patients with single magnet ingestions experienced morbidity or severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations, perforations (44.3%), severe intestinal necrosis (19.3%), peritonitis (13.6%), severe abdominal infection (10.2%), and septic shock (4.5%). The rate of surgical intervention (59.1% vs. 1.0%) and gastroscopy (15.9% vs. 3.0%) was significantly higher in the multiple ingestion group compared to the single magnet ingestion group. No deaths were identified. A high risk of serious complications, including the need for surgery to remove the magnets and substantial morbidity may result from swallowing more than one magnet. Magnet safety requirements, public education, and improved legislation are urgently required.
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Affiliation(s)
- Amani N Alansari
- Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar.
| | - Temur Baykuziyev
- Department of Anesthesiology, ICU and Perioperative Medicine, Hamad General Hospital, Doha, Qatar
| | - Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Servet Melike Akıncı
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Khalid Khalfan Al Ali
- Department of Pediatric Surgery, Al Qassimi Women and Children's Hospital, Sharjah, United Arab Emirates
| | - Adel Aljneibi
- Department of Pediatric Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Nafea Hussain Alyasi
- Department of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Muhammad Afzal
- Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Kingdom of Saudi Arabia
| | - Amine Ksia
- Department of Pediatric Surgery, Faculty of Medicine, Fattouma Bourguiba Hospital, Monastir, Tunisia
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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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Zhang RY, Cai P, Zhang TT, Zhu J, Chen JL, Zhao HW, Jiang YL, Wang Q, Zhu ML, Zhou XG, Xiang XL, Hu FL, Gu ZC, Zhu ZW. Clinical predictors of surgical intervention for gastrointestinal magnetic foreign bodies in children. BMC Pediatr 2023; 23:323. [PMID: 37355569 PMCID: PMC10290319 DOI: 10.1186/s12887-023-04125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND/AIMS To investigate the clinical situation, treatment methods, and clinical predictors of surgical intervention in children with magnetic foreign bodies in the digestive tract. MATERIALS AND METHODS From January 2019 to June 2022, we retrospectively analyzed the clinical data of 72 children who ingested magnetic foreign bodies inadvertently in our hospital, including their general information, admissions, clinical manifestations, and treatment methods, as well as pertinent literature and statistical data. Following software processing, univariate and multivariate logistic regression analyses were conducted to determine the independent risk factors of this study. RESULTS In this study, 16 patients (22.2%) were discharged smoothly following conservative treatment and 19 patients (26.4%) were cured by gastroscopy. The remaining 37 patients (51.4%) were underwent surgery, in which 26 cases developed gastrointestinal perforation. There were statistical differences between surgery group and non- surgery group in the days of eating by mistake, clinical manifestations (nausea and vomiting, intermittent abdominal pain, abdominal muscle tension) and movement trajectory by every 24-h radiograph (P < 0.01). Logistic regression analysis showed that intermittent abdominal pain and abdominal muscle tension were independent risk factors for surgical treatment. CONCLUSION Magnetic foreign bodies seriously endanger children's health. This study offers a single-center basis for the choice of surgical opportunity for intestinal obstruction or perforation caused by magnetic foreign bodies. Clinicians need immediate surgical intervention if the child shows symptoms of abdominal pain or abdominal tension.
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Affiliation(s)
- Rui Yun Zhang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Peng Cai
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Ting Ting Zhang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Jie Zhu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Jian Lei Chen
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Hao Wei Zhao
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Yu Liang Jiang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Qi Wang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Meng Lei Zhu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Xiao Gang Zhou
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Xian Lan Xiang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Fei Long Hu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Zhi Cheng Gu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China
| | - Zhen Wei Zhu
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215127, Jiangsu Province, China.
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Pediatric Foreign Body Ingestion: Complications and Patient and Foreign Body Factors. SCI 2022. [DOI: 10.3390/sci4020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Management of the child who has swallowed a foreign body should be guided by the risk of complication. Objective of the Review: This review discusses the patient and foreign body characteristics most likely to be associated with complications. Discussion: Most swallowed foreign bodies will pass through the GI tract without complication. Children with pre-existing GI tract abnormalities of any sort, or those who swallow higher-risk foreign bodies, are at higher risk. Higher-risk foreign bodies include long, sharp, or pointed objects, button batteries, and small magnets. Nearly any child who presents to an Emergency Department or other acute care setting after foreign body ingestion should undergo plain radiography; other forms of imaging may also be appropriate. Primary care providers may opt for an initial observation period when there is lower risk of complication. Esophageal button batteries should be emergently removed; other esophageal objects should be promptly removed or, if low risk, allowed a brief period to pass spontaneously. Most lower GI tract foreign bodies will pass spontaneously. Prevention, while not always possible, is preferable to management of foreign body ingestion. Conclusions: Management strategies for children who have swallowed foreign bodies can be optimized by considering relevant patient and foreign body factors, and how they contribute to the risk of complication.
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Middelberg LK, Leonard JC, Shi J, Aranda A, Brown JC, Cochran CL, Eastep K, Gonzalez R, Haasz M, Herskovitz S, Hoffmann JA, Koral A, Lamoshi A, Levitte S, Lo YHJ, Montminy T, Novak I, Ng K, Novotny NM, Parrado RH, Ruan W, Shapiro J, Sinclair EM, Stewart AM, Talathi S, Tavarez MM, Townsend P, Zaytsev J, Rudolph B. High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study. Pediatrics 2022; 149:184737. [PMID: 35112127 DOI: 10.1542/peds.2021-054543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES High-powered magnets were effectively removed from the US market by the Consumer Product Safety Commission (CPSC) in 2012 but returned in 2016 after federal court decisions. The United States Court of Appeals for the 10th Circuit cited imprecise data among other reasons as justification for overturning CPSC protections. Since then, incidence of high-powered magnet exposure has increased markedly, but outcome data are limited. In this study, we aim to describe the epidemiology and outcomes in children seeking medical care for high-powered magnets after reintroduction to market. METHODS This is a multicenter, retrospective cohort study of patients aged 0 to 21 years with a confirmed high-powered magnet exposure (ie, ingestion or insertion) at 25 children's hospitals in the United States between 2017 and 2019. RESULTS Of 596 patients with high-powered magnet exposures identified, 362 (60.7%) were male and 566 (95%) were <14 years of age. Nearly all sought care for magnet ingestion (n = 574, 96.3%), whereas 17 patients (2.9%) presented for management of nasal or aural magnet foreign bodies, 4 (0.7%) for magnets in their genitourinary tract, and 1 patient (0.2%) had magnets in their respiratory tract. A total of 57 children (9.6%) had a life-threatening morbidity; 276 (46.3%) required an endoscopy, surgery, or both; and 332 (55.7%) required hospitalization. There was no reported mortality. CONCLUSIONS Despite being intended for use by those >14 years of age, high-powered magnets frequently cause morbidity and lead to high need for invasive intervention and hospitalization in children of all ages.
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Affiliation(s)
- Leah K Middelberg
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie C Leonard
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Junxin Shi
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Arturo Aranda
- Division of Pediatric Surgery, Dayton Children's Hospital, Dayton, Ohio
| | - Julie C Brown
- Seattle Children's Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Christina L Cochran
- Department of Pediatrics, Division of Emergency Medicine, Children's of Alabama, University of Alabama at Birmingham College of Medicine, Birmingham, Alabama
| | - Kasi Eastep
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Norton Children's Hospital affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Maya Haasz
- Department of APediatrics, Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Scott Herskovitz
- Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, San Diego, California
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexander Koral
- Department of Pediatrics, Section of Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Abdulraouf Lamoshi
- Division of Pediatric Surgery, Cohen Children's Medical Center; Northwell Health, Queens, New York
| | - Steven Levitte
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Yu Hsiang J Lo
- Department of Emergency Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Taylor Montminy
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Inna Novak
- Children's Hospital at Montefiore, Albert Einstein College of Medicine; Bronx, New York
| | - Kenneth Ng
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan M Novotny
- Beaumont Children's, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Raphael H Parrado
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, South Carolina
| | - Wenly Ruan
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Joseph Shapiro
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Elizabeth M Sinclair
- Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Healthcare of Atlanta, Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia
| | - Amanda M Stewart
- Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Saurabh Talathi
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Oklahoma Children's Hospital, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Melissa M Tavarez
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Peter Townsend
- Department of Pediatrics, Division of Gastroenterology, Connecticut Children's Hospital, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Julia Zaytsev
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Bryan Rudolph
- Children's Hospital at Montefiore, Albert Einstein College of Medicine; Bronx, New York
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Xin Y, Jia LQ, Dong YW, Wang Y, Hu YX, Wang XM. Application of high-frequency ultrasound in the diagnosis of gastrointestinal magnet ingestion in children. Front Pediatr 2022; 10:988596. [PMID: 36714638 PMCID: PMC9880474 DOI: 10.3389/fped.2022.988596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of magnet ingestion by children has recently increased in China. Magnet ingestion is associated with an extremely high risk of gastrointestinal damage because loops of bowel can become trapped and squeezed between multiple magnets in different locations. However, the lack of imaging sensitivity makes clinical decision-making difficult. OBJECTIVE This study was conducted to investigate the performance of ultrasound in diagnosing gastrointestinal magnet ingestion in children. METHODS From April 2017 to February 2021, all children with a history of magnet ingestion or a diagnosis of gastrointestinal magnet as shown by x-ray or ultrasound in our hospital were included as study candidates. Patients who were lost to follow-up or had known malformations of the gastrointestinal tract were excluded. Eligible patients were those with surgical or endoscopic confirmation of gastrointestinal magnet, those who passed the magnet out of the alimentary tract without assistance, and those with confirmed absence of the magnet on abdominal x-ray examination after 1 month of conservative treatment. All eligible patients' ultrasound and x-ray examination data were evaluated. The sensitivity, specificity, and area under the curve (AUC) of ultrasound was calculated for diagnosing magnet ingestion, locating the magnet (stomach, small intestine, or colon), and confirming the phenomenon of wall entrapment. RESULTS Of 112 patients, 107 had a magnetic foreign body and 5 did not. Magnets were correctly detected by ultrasound in 97 patients, with an observed sensitivity of 90.65% and specificity of 100%. Satisfactory sensitivity was obtained for ultrasound localization of gastric magnets (96.30%) and small intestinal magnets (100.00%), but sensitivity for ultrasound localization of colonic magnets was relatively poor (73.33%). The discrimination of wall entrapment by ultrasound was good (AUC = 0.93), with an observed sensitivity and specificity of 92.00% and 93.62%, respectively. CONCLUSIONS Ultrasound can be used to locate gastrointestinal magnets (in the stomach, small intestine, or colon) with good clinical efficacy in identifying wall entrapment.
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Affiliation(s)
- Yue Xin
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Qun Jia
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ya Wei Dong
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yan Xiu Hu
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiao Man Wang
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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