Swallowed magnets and batteries: a dangerous but not unexpected attraction

Surgical management of pediatric multiple magnet ingestions in the past two decades of minimal access surgery- systematic review of operative approaches

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.

Takes two to tango

A 17-year-old girl was admitted with acute abdominal pain, vomiting and a leucocytosis, and was initially thought to have appendicitis. She underwent laparoscopic appendicectomy, where the tip of the appendix was noted to be mildly inflamed and she was discharged home the day after surgery. Two days later, she re-presented with small bowel obstruction which was subsequently demonstrated to be due to ingestion of five magnetic beads. She required a laparotomy and small bowel resection to resolve the obstruction, but has since fully recovered. This case highlights the potential intestinal complications caused by the intake of magnetic objects, and based on a literature review a number of recommendations are made to guide clinicians when managing similar cases.