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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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Table of Contents   
CASE REPORT
Year : 2013  |  Volume : 18  |  Issue : 4  |  Page : 160-161
 

Multiple magnet ingestion: An uncommon cause of peritonitis


Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India

Date of Web Publication8-Nov-2013

Correspondence Address:
Shraddha Verma
Department of Pediatric Surgery, 5th Floor, Chacha Nehru Bal Chikitsalaya, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.121126

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   Abstract 

Foreign body ingestion is common in infants and young children and they pass spontaneously in most of the cases. Magnetic foreign bodies, though not very common, require early intervention to avoid severe gastrointestinal complications. We report a case of multiple magnet ingestion who presented with peritonitis.


Keywords: Gastrointestinal, magnetic foreign body, pediatric


How to cite this article:
Verma S, Shinde S, Gupta CR. Multiple magnet ingestion: An uncommon cause of peritonitis. J Indian Assoc Pediatr Surg 2013;18:160-1

How to cite this URL:
Verma S, Shinde S, Gupta CR. Multiple magnet ingestion: An uncommon cause of peritonitis. J Indian Assoc Pediatr Surg [serial online] 2013 [cited 2019 Nov 15];18:160-1. Available from: http://www.jiaps.com/text.asp?2013/18/4/160/121126



   Introduction Top


Infants and small children instinctively put anything in the mouth. Nearly, 80% of the ingested foreign bodies pass from the gastrointestinal tract without any complication. [1],[2] Rounded foreign bodies with no sharp edges, if found beyond esophagus, are usually the left for spontaneous passage. However, multiple magnetic foreign bodies if managed conservatively may lead to severe gastrointestinal morbidity and extensive surgery. We report an infant who came with peritonitis after ingestion of multiple magnets.


   Case Report Top


A 1-year-old child presented with the complaints of pain in the abdomen and constipation for 4 days, progressively increasing abdominal distension for 3 days and several episodes of bilious vomiting for 2 days. There was no history of fever or preceding diarrhea. She was hemodynamically stable. Abdomen was distended, tense and tender and guarding was present. Bowel sounds were absent. Abdominal radiograph showed distended bowel loops with multiple air fluid levels, absence of distal bowel gas and a foreign body with no free air in the peritoneal cavity [Figure 1]a. Parents could not recall any foreign body of that nature even after seeing the radiograph. After initial resuscitation, exploratory laparotomy was performed. There was no gross peritoneal contamination. One tiny perforation was found 25 cm distal to duodeno-jejunal flexure and 3-4 sealed perforations were found spread in 3 cm length of proximal ileum. The segment of ileum having multiple perforations was resected and five metallic beads could be palpated and removed from small bowel separately in the set of 2, 2 and 1. Jejunal perforation was primarily repaired. These beads were magnetic and took similar shape when put together as was seen on radiograph [Figure 1]b. The beads when shown to mother were recognized as beads from the magnetic bracelet, which got broken a week earlier. The child did well in the post-operative period and was discharged on full oral feeds on the post-operative day 6.
Figure 1: (a) Abdominal radiograph showing distended bowel loops with multiple air fluid levels, absence of distal bowel gas and a foreign body with no free air. (b) Magnetic beads after removal from small bowel

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   Discussion Top


Less than 55 cases of multiple magnet ingestion have been reported in the English literature till date. [3] Similar to our case, history of foreign body ingestion is either not found or a week old. Patients are either young children (6 months to 3 years) or older children with autism. [4] The magnets are usually part of toys or household electronic items, beads from jewelry used for magnetic therapy or broken pieces from a large magnet. These are usually ingested on separate occasions or they get separated when they pass through the pylorus. [5]

Small bowel is the site of morbidity in most of the cases. The cause of preferential small bowel injury in these cases is mobility and thin walls of the small intestine. Magnets in the small bowel lumen attract each other through thin walls and attach to each other if they are in adjacent loops. This causes ischemia and necrosis of adjacent bowel and leads to perforation or bowel fistulization and other complications. [4]

Most of the patients reported in the literature, presented with complications such as perforation peritonitis, entero-enteric fistulae, obstruction, volvulus and internal herniation. Magnets were retrieved after laparotomy. In few cases, magnets have also been removed even in asymptomatic patients to avoid complications. [6]

In day-to-day practice, if we see a metallic foreign body without sharp edges, we usually wait for spontaneous passage through gastrointestinal tract and monitor it with plain abdominal radiograph. The ingestion of multiple magnets poses a significantly different clinical problem compared with the other foreign bodies or the ingestion of a single magnet. They can lead to severe gastrointestinal morbidity if left untreated. If in stomach, they should be removed with endoscopy [7],[8] or a catheter with magnetic tip. [9] If passed distal to pylorus, prompt surgical intervention is required before a complication develops [Figure 2].
Figure 2: Algorithm for management of magnetic foreign body ingestion

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To conclude, the clinicians should be aware of the hazards of multiple magnet ingestion and should opt for an early intervention even in the asymptomatic patient. Conservative approach in these patients can lead to severe gastrointestinal complications, extensive surgery and its consequent morbidity and mortality.

 
   References Top

1.Lee SK, Beck NS, Kim HH. Mischievous magnets: Unexpected health hazard in children. J Pediatr Surg 1996;31:1694-5.  Back to cited text no. 1
    
2.Vijaysadan V, Perez M, Kuo D. Revisiting swallowed troubles: Intestinal complications caused by two magnets - A case report, review and proposed revision to the algorithm for the management of foreign body ingestion. J Am Board Fam Med 2006;19:511-6.  Back to cited text no. 2
    
3.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.  Back to cited text no. 3
    
4.Oestreich AE. Danger of multiple magnets beyond the stomach in children. J Natl Med Assoc 2006;98:277-9.  Back to cited text no. 4
    
5.Robinson AJ, Bingham J, Thompson RL. Magnet induced perforated appendicitis and ileo-caecal fistula formation. Ulster Med J 2009;78:4-6.  Back to cited text no. 5
    
6.Zampieri N, Consolaro G, Ottolenghi A, Camoglio FS. Unusual diagnosis of multiple magnet ingestion R1. Pediatr Int 2010;52:e14-6.  Back to cited text no. 6
    
7.Hachimi-Idrissi S, Corne L, Vandenplas Y. Management of ingested foreign bodies in childhood: Our experience and review of the literature. Eur J Emerg Med 1998;5:319-23.  Back to cited text no. 7
    
8.Kim JK, Kim SS, Kim JI, Kim SW, Yang YS, Cho SH, et al. Management of foreign bodies in the gastrointestinal tract: An analysis of 104 cases in children. Endoscopy 1999;31:302-4.  Back to cited text no. 8
    
9.Suita S, Ohgami H, Yakabe S, Nagasaki A. The fate of swallowed button batteries in children. Z Kinderchir 1990;45:212-4.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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