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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; 76:1203-1211. [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] [MESH Headings] [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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Schaffer O, Kenoshi A, Zmora O. Early colonic-preparation and salvage laparoscopic appendectomy (ECSLA)- innovative protocol for the management of magnets ingestion. Int J Emerg Med 2024; 17:88. [PMID: 39009975 PMCID: PMC11247818 DOI: 10.1186/s12245-024-00678-2] [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: 03/02/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Ingestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity. METHODS The Early Colonic-preparation and Salvage Laparoscopic Appendectomy (ECSLA) protocol includes initiating colonoscopy preparation upon admission in asymptomatic patients if magnets are not amenable to removal by gastroscopy, and laparoscopic magnets retrieval via appendectomy if surgery is eventually needed. The protocol was initiated in May 2023. A retrospective study of all cases of ingested magnets in children in our institution during July 2020 - January 2024 was conducted to retrieve and analyze demographic, clinical, imaging, management, and outcome data. RESULTS During the 3.5-year study period, 13 cases of ingested multiple magnets were treated, including 7 cases since initiation of ECLSA protocol, with no complications. Since initiation of ECSLA protocol, Early colonic preparation resulted in spontaneous passage of magnets (two cases) and successful colonocsopic removal (three cases), with two cases in which magnets were retrieved via gastroscopy upon admission, and no patients needing surgical intervention. Length of stay (LOS) was short (1-3 days). CONCLUSIONS The ECSLA protocol is a promising tool for preventing surgical intervention and complications and for possibly shortening LOS in children who have ingested multiple magnets.
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Affiliation(s)
- Ortal Schaffer
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Kenoshi
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Zmora
- Shamir medical center, Department of Pediatric Surgery, Zerifin, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Endoscopic gastrointestinal anastomosis: a review of established techniques. Gastrointest Endosc 2021; 93:34-46. [PMID: 32593687 DOI: 10.1016/j.gie.2020.06.057] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023]
Abstract
Technologic advancements in the field of therapeutic endoscopy have led to the development of minimally invasive techniques to create GI anastomosis without requiring surgery. Examples of the potential clinical applications include bypassing malignant and benign gastric outlet obstruction, providing access to the pancreatobiliary tree in those who have undergone Roux-en-Y gastric bypass, and relieving pancreatobiliary symptoms in afferent loop syndrome. Endoscopic GI anastomosis is less invasive and less expensive than surgical approaches, result in improved outcomes, and therefore are more appealing to patients and providers. The aim of this review is to present the evolution of luminal endoscopic gastroenteric and enteroenteric anastomosis dating back to the first compression devices and to describe the clinical techniques being used today, such as magnets, natural orifice transluminal endoscopic surgery, and EUS-guided techniques. Through continued innovation, endoscopic interventions will rise to the forefront of the therapeutic arsenal available for patients requiring GI anastomosis.
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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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Foreign body ingestion in children. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000531234.16566.2a] [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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Mason J, Sacchetti A, Herbert M, Jhun P. Just How Good Are Handheld Metal Detectors for Ingested Foreign Bodies? Ann Emerg Med 2017; 69:516-518. [DOI: 10.1016/j.annemergmed.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Removal and management of esophageal foreign bodies. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2013.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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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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Meiyappan V, Ah Yen D, Al Herz F, Meiyappan A, Knight DH. Opposites attract: operative considerations in magnet ingestion. ANZ J Surg 2013; 83:587-8. [DOI: 10.1111/ans.12233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Vivek Meiyappan
- General Surgery; Hawkes Bay District Health Board; Hastings; New Zealand
| | - Damien Ah Yen
- Southern District Health Board; Dunedin; New Zealand
| | - Fathel Al Herz
- General Surgery; Hawkes Bay District Health Board; Hastings; New Zealand
| | | | - Douglas H. Knight
- General Surgery; Hawkes Bay District Health Board; Hastings; New Zealand
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Ozgenc F, Yuksekkaya HA, Erdemir G, Ecevit CO, Yagci RV. Stress magnet ingestion in three children: Endoscopist perspective. Interv Med Appl Sci 2012. [DOI: 10.1556/imas.4.2012.3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
The widespread use of magnets in toy industry has resulted in increased reports of magnet ingestions and related complications. Ensconcing within plastic covers and manufacturing larger pieces have been forwarded to avoid ingestion. We report 3 cases of magnet ingestion called “stress magnets” which are large to pass the gastric outlet. Endoscopic retrieval of single and double magnets from the stomach is described, and magnet related health hazard as well as the procedure related adversities is discussed.
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Affiliation(s)
- Funda Ozgenc
- 1 Department of Pediatric Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Hasan Ali Yuksekkaya
- 1 Department of Pediatric Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Gulín Erdemir
- 1 Department of Pediatric Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Cigdem Omur Ecevit
- 1 Department of Pediatric Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Rasit Vural Yagci
- 1 Department of Pediatric Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
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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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12
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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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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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15
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Brown JC, Murray KF, Javid PJ. Hidden attraction: a menacing meal of magnets and batteries. J Emerg Med 2012; 43:266-9. [PMID: 22244292 DOI: 10.1016/j.jemermed.2011.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/16/2011] [Accepted: 09/20/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND Magnet and button battery ingestions are increasingly common, and can result in significant morbidity. Timely identification of hazardous foreign body ingestions can be difficult in non-verbal and non-disclosing children. OBJECTIVES We aim to present a case that demonstrates some of the challenges around identifying and correctly locating magnets and batteries, and the importance of prompt identification and removal. CASE REPORT We describe an older child with the covert ingestion of multiple magnets and batteries, with magnets that attracted across the stomach and a loop of jejunum. Mild symptoms and signs resulted in a delayed diagnosis and serious consequences. Radiographs suggested a gastric location of the foreign bodies. CONCLUSION Health care workers should consider the possibility of battery or magnet ingestions in children with vomiting and abdominal pain, even when well-appearing. Like esophageal batteries, multiple gastrointestinal magnets and combined magnet-battery ingestions can cause significant morbidity, and prompt identification is important. Providers should ask verbal children for ingestion histories, and consider radiographs when symptoms are atypical or persistent. Like esophageal batteries, gastrointestinal magnet-battery ingestions should be removed promptly to prevent complications. Caregivers should supervise or limit the use of toys that include magnets and batteries.
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Affiliation(s)
- Julie C Brown
- Seattle Children's Hospital and University of Washington, Seattle, Washington 98105, USA
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Myers C, Yellen B, Evans J, DeMaria E, Pryor A. Using external magnet guidance and endoscopically placed magnets to create suture-free gastro-enteral anastomoses. Surg Endosc 2009; 24:1104-9. [PMID: 20033734 DOI: 10.1007/s00464-009-0735-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 10/02/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND To facilitate endolumenal and natural orifice procedures, this study evaluated a novel technique using external and endoscopically placed magnets to create suture-free gastroenteral anastomoses. METHODS Seven anesthetized adult swine underwent endoscopic placement of magnets into the small bowel and stomach. Using external magnets, the endoscopically placed internal magnets were brought into opposition under endoscopic view. After 1-2 weeks, the pigs were killed and analyzed. At laparotomy and under sterile conditions, peritoneal cultures were obtained. The anastomoses were evaluated endoscopically and tested using an air insufflation test. Finally, the anastomoses were resected and evaluated microscopically. RESULTS The average operative time for endoscopic placement of the magnets was 34.3 +/- 14.8 min. Successful placement and creation of anastomoses occurred in six of the pigs. One pig did not form an anastomosis because the magnets were too large to pass through the pylorus at the time of attempted magnet placement. Six swine experienced uncomplicated postoperative courses. One pig's postoperative course involved constipation for several days, requiring additional fluids and fiber supplementation. The findings at endoscopy showed that the magnets were adhered to the anastomosis, which were easily freed, or within the stomach. The air insufflation test results were negative for all the pigs. At laparotomy, there was no evidence of infection, abscess, or leak, but two peritoneal culture results were positive with scant growth of Staphylococcus aureus and coagulase-negative staphylococcus, presumably contaminants. Microscopically, the anastomoses illustrated granulation and fibrous connective tissue without evidence of infection or leak. CONCLUSION Endoscopically placed magnets with external magnet guidance is a feasible and novel approach to creating patent gastroenteral anastomoses without abdominal incisions or sutures.
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Affiliation(s)
- Christopher Myers
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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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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Chang YS, Song JY, Choi SI. Ileal Perforation Caused by Ingestion of Multiple Magnets. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.4.270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yeon Soo Chang
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jeong Yoon Song
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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