Associate Pediatric Surgery King Abdulla bin Abdul-Aziz
University Hospital _ PNU
Magnetic Toys Ingestion In Children
Dr. Ali M Ahmad Consultant Pediatric Surgery;
MBBCh, MS, MD, MRCS-Ed, EBPS
FBs ingestion is a common clinical problem in young children.
Fortunately, most FBs usually cause no harm and spontaneously come out of the rectum without treatment.
Introduction
The incidence of FB ingestion is > 100,000 patients annually in the United States & > 80% of these occur in the pediatric population with 98% of these being accidental.
The majority of FBs that reach the stomach will pass through the GI spontaneously with no consequence.
Endoscopic retrieval is required in 10% to 20%.
< 1% will require surgical intervention
Review [1, 2].
FBs that require endoscopic or
surgical removal are
Large enough to cause obstructionSharp edgesTransmural injury by caustic or mechanical forces.
Review [3]
The Aim Highlights this serious problem & its
management
Two cases with MM toys ingestions
A 5-year-old girl
History of ingestion of a piece of magnetic toy
She visited the ER many times
Based on stable clinical condition & the x-ray findings the patient reassured & discharge home ; that the FB will pass spontaneously.
Three months later she presented to our ER
with acute abdominal pain
Repeated x-ray confirmed the presence of two FBs.
Colonoscopy 26-08-2009 Shows sever inflammation
Jejuno-cecal fistula at 40 cm from du- jejunal junction
Two ovals powerful magnetic toys {measure 3.8 x 1.3}
A 2-year-old girl.
with history of ingestion of a pieces of magnetic toys.
She visited the ER many times.
Based on stable here benign clinical condition ;the patient discharged home with reassurance that the object would pass spontaneously.
Two months later She presented to our ER with acute abdominal
pain.
Laparotomy
Uneventful postoperative
DC home 5th & 7th POD
Ingestion of magnets by children has recently come to greater attention due to
The death of a 2-year-old boy in Washington State, USA after swallowing pieces of the
magnetized playset Magnetix1 (Rose Art Industries Inc., Livingston, NJ)
Review [4]
Recent improvements in manufacturing processes
have made Small, Powerful Magnets
Inexpensive & Readily Available
increasing the potential for exposure of children to
magnets in toys and other products.
Review [5].
Complications associated with
Magnetic FBs ingestions are still underestimated
Attraction of two or more magnets across the walls of multiple loops of bowel
causes ischemia and necrosis that lead to
Obstruction, Ulceration, Fistula, Perforation, Volvulus and Strangulation
Review [6, 7]
If the ingested FB is revealed on a plane radiographand the position becomes fixed on serial radiographs
There should be Suspicion of ingesting multiple magnets
Review [9]
Plain radiography lack the sensitivity to determine the multiplicity of FBs.
Review [8]
IF THE INGESTED MULTIPLE MAGNETS
Pass the pylorus on the abdominal radiography
Should be removed immediately by laparotomy before any symptoms or complications occur
Review [10].
MM ingestion can lead to serious GI complications
MM ingestion, compared to a single magnet, is a distinct clinical situation that needs to be managed differently.
Think for MM if FBs fixed in position on X-ray
Conclusions
Surgery is Recommended if MM passed the pylorus
Awareness among; Clinicians , public & toys manufacturing about this health hazards may improve the outcome.
Conclusions
1. Butterworth J, Feltis B. Toy magnet ingestion in children: revising the algorithm. J Pediatr Surg 2007; 42, E3–E5.2. Alzahem A, Soundappan S, Jefferies H, Cass D. Ingested magnets and gastrointestinal complications. Journal of
Paediatrics and Child Health 2007; 43, 497–8.3. Pryor H, Lange P, Bader A, Gilbert J, Newman K. Multiple Magnetic Foreign Body Ingestion: A Surgical Problem. J
Am Coll Surg 2007; 205, 182-6. 4. Fenton S, Torgenson M, Holsti M, Black R. Magnetic attraction leading to a small bowel obstruction in a child.
Pediatr Surg Int 2007; 23, 1245–7.5. McCormick S, Brennan P, Yassa J, Shawis R. Children and mini-magnets: an almost fatal attraction. Emerg Med J
2002; 19, 71–3.6. Robinson A, Bingham J, Thompson R. Magnet induced perforated appendicitis and ileo-caecal fistula formation.
Ulster Med J 2009; 78 (1) 4-6.7. Liu S, Blacam C, Lim F, Mattei P, Mamula P. Magnetic Foreign Body Ingestions Leading to Duodenocolonic
Fistula. JPediatr Gastroenterol Nutr, 2005; 41, 670- 672.8. Anselmi E, Roman C, Fontoba J, Gonza´lez L, Dieguez E, Gonza´lez J, et al. Intestinal perforation caused by
magnetic toys. J Pediatr Surg 2007; 42, E13–E16.9. Nui A, Hirama T, Katsuramaki T, Maeda T, Meguro M, Nagayama M, et al. An intestinal volvulus caused by
multiple magnet ingestion: an unexpected risk in children. J Pediatr Surg 2005; 40, E9–E11. 10.Kim J. Gastrojejunal Fistula with Jejunal Rotation Caused by Two Ingested Magnets in a Child: A Case Report. J
Korean Radiol Soc 2006; 55,153-156.
References
Associate Pediatric Surgery King Abdulla bin Abdul-Aziz
University Hospital _ PNU
Underestimation Of Magnetic Toys Ingestion In Children May Leads To Serious Gastrointestinal
Complications
Dr. Ali M Ahmad Consultant Pediatric Surgery;
MBBCh, MS, MD, MRCS-Ed, EBPS
Thank you
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