1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Li XL, Zhang QM, Lu SY, Liu TT, Li SL, Chen L, Xie FN, Wang L, Zhang CH, Wang DY, Huang LM. Accidental ingestion of multiple magnetic beads by children and their impact on the gastrointestinal tract: a single-center study. BMC Pediatr 2024; 24:5. [PMID: 38172693 PMCID: PMC10763124 DOI: 10.1186/s12887-023-04425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE In this study, we aimed to enhance the treatment protocols and help understand the harm caused by the accidental ingestion of magnetic beads by children. METHODS Data were collected from 72 children with multiple gastrointestinal perforations or gastrointestinal obstructions. The 72 pediatric patients were divided into a perforation and a non-perforation group. The data collected for the analysis included the gender, age, medical history, place of residence (rural or urban), and symptoms along with the educational background of the caregiver, the location and quantity of any foreign bodies discovered during the procedure, whether perforation was confirmed during the procedure, and the number of times magnetic beads had been accidentally ingested. RESULTS The accuracy rate of preoperative gastrointestinal perforation diagnosis via ultrasound was 71%, while that of the upright abdominal X-ray method was only 46%. In terms of symptoms, the risk of perforation was 13.844 and 12.703 times greater in pediatric patients who experienced vomiting and abdominal pain with vomiting and abdominal distension, respectively, compared to patients in an asymptomatic state. There were no statistical differences between the perforation and the non-perforation groups in terms of age, gender, medical history, and the number of magnetic beads ingested (P > 0.05); however, there were statistical differences in terms of white blood cell count (P = 0.048) and c-reactive protein levels (P = 0.033). A total of 56% of cases underwent a laparotomy along with perforation repair and 19% underwent gastroscopy along with laparotomy. All pediatric patients recovered without complications following surgery. CONCLUSION Abdominal ultrasonography and/or upright abdominal X-ray analyses should be carried out as soon as possible in case of suspicion of accidental ingestion of magnetic beads by children. In most cases, immediate surgical intervention is required. Given the serious consequences of ingesting this type of foreign body, it is essential to inform parents and/or caregivers about the importance of preventing young children from using such products.
Collapse
Affiliation(s)
- Xian-Ling Li
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Qin-Ming Zhang
- Department of Surgery, Beijing United Family Hospital, 100015, Beijing, China
| | - Shou-Yan Lu
- Department of Surgery, Beijing Aiyuhua Women's and Children's Hospital, 100176, Beijing, China
| | - Ting-Ting Liu
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Shuan-Ling Li
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Long Chen
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Fang-Nan Xie
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Li Wang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Chuang-Hui Zhang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Da-Yong Wang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China.
| | - Liu-Ming Huang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Xicheng District, 100045, Beijing, China.
| |
Collapse
|
3
|
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.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Li XL, Zhang QM, Lu SY, Liu TT, Yao ZM, Zhang WP, Chen YJ, Chen L, Xie FN. Clinical report and analysis of 24 cases of multiple magnetic beads foreign body in gastrointestinal tract of children. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:819-824. [PMID: 33361046 DOI: 10.5152/tjg.2020.19600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS This study aimed to analyze the data of 24 cases of multiple perforation or obstruction of the digestive tract caused by accidental ingestion of magnetic beads, to improve the understanding of its harmfulness to children and explore the best treatment. MATERIALS AND METHODS In total, 24 cases were collected and retrospectively analyzed. These patients were divided into two groups: perforation group and non-perforation group. The medical history, number of magnetic beads, white blood cell (WBC) count, and C-reactive protein (CRP) were analyzed. RESULTS There was no significant difference in age, gender, medical history, number of magnetic beads, and WBC count between the perforation group and non-perforation group, but there was a significant difference in CRP. After the diagnosis, 70% of the cases underwent laparotomy and perforation repair. All cases recovered smoothly after the operation, and no complications occurred during the follow-up. CONCLUSION This study offers diagnosis and treatment methods for the perforation or obstruction of the digestive tract caused by accidental ingestion of magnetic beads and raises the awareness regarding the harmfulness of the presence of foreign bodies in the digestive tract.
Collapse
Affiliation(s)
- Xian-Ling Li
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qin-Ming Zhang
- Department of Surgery, Beijing United Family Hospital, Beijing, China
| | - Shou-Yan Lu
- Department of Surgery, Beijing Aiyuhua Women's and Children's Hospital, Beijing, China
| | - Ting-Ting Liu
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zi-Ming Yao
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wei-Ping Zhang
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ya-Jun Chen
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Long Chen
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Fang-Nan Xie
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| |
Collapse
|
7
|
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
|
8
|
Zachos K, Panagidis A, Georgiou G, Alexopoulos V, Sinopidis X. Double Jejunoileal Fistula after Ingestion of Magnets. J Indian Assoc Pediatr Surg 2019; 24:63-64. [PMID: 30686890 PMCID: PMC6322187 DOI: 10.4103/jiaps.jiaps_92_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A double jejunoileal fistula was diagnosed intraoperatively 10 months since a 4-year-old boy had swallowed an object consisted of multiple magnetic items. Magnet ingestion presents characteristics that are misdiagnosing, critical time-consuming, dangerous, and occasionally fatal. The particularities and pitfalls of ingested magnetic items are outlined.
Collapse
Affiliation(s)
- Konstantinos Zachos
- Department of Pediatric Surgery, Karamandaneion Pediatric General Hospital of Patras, Patras, Greece
| | - Antonios Panagidis
- Department of Pediatric Surgery, Karamandaneion Pediatric General Hospital of Patras, Patras, Greece
| | - George Georgiou
- Department of Pediatric Surgery, Karamandaneion Pediatric General Hospital of Patras, Patras, Greece
| | - Vasileios Alexopoulos
- Department of Pediatric Surgery, Karamandaneion Pediatric General Hospital of Patras, Patras, Greece
| | - Xenophon Sinopidis
- Department of Pediatric Surgery, University General Hospital of Patras, University of Patras School of Medicine, Patras, Greece
| |
Collapse
|