B. J. Slater1, T. Tran2, M. Slidell1 1University Of Chicago,Pediatric Surgery,Chicago, IL, USA, 2University of Illinois at Chicago Metropolitan Group Hospitals,Surgery,Chicago, IL, USA
Introduction: Magnet ingestion and its complications in children have been well described. When multiple magnets or a magnet and a second magnetic object are swallowed, complications can arise because they can attract each other between two loops of intestine leading to intestinal necrosis, fistulation, obstruction, or perforation. Although some algorithms have been proposed, there are no definitive guidelines for the evaluation and management of these patients and there is significant variation in practices. Multiple radiographs, CT scans, and other imaging modalities are often used to assess for position, progression, and signs of complications. In addition, some advocate for early surgical intervention to remove the magnets. The purpose of this study was to review the outcomes of patients with magnet ingestion at several institutions and determine the feasibility of minimizing the number of radiographs and invasive procedures for selected patients with magnet ingestion.
Methods: This is a retrospective study evaluating 20 patients with magnet ingestion at 4 institutions from 6/2012 until 12/2017. Demographic, diagnostic, and therapeutic procedures were recorded. Magnet ingestion features such as location, symptoms, and complications were included.
Results: The median age was 8 years (2.7-13) and weight was 27.3kg (range 17 to 48). 70% of the patients were male. 75% of patients ingested multiple magnets or a magnet and another metallic object, and the average number of magnets ingested was 4.2 (range 1 to 30). 20% of the patients were symptomatic at admission. All of the patients had plain radiographs (average number 4.3, range 1 to 10), 4 had CT scans, and 1 had an UGI study. 40% of the patients (8) had a bowel regimen in the hospital, 35% (7) underwent endoscopy, and 35% (6) underwent surgical procedures. 45% of the patients had no intervention. Of patients who underwent surgery, half were performed laparoscopically and half were begun laparoscopically with exteriorization of bowel through the umbilicus. Having symptoms, especially pain, was correlated with having an intervention (correlation factor .6)
Conclusion: Magnet ingestion in children is associated with complications. There are a subset of asymptomatic patients in whom surveillance with decreased number of radiographs and possible outpatient observation may be feasible.
