Gastrointestinal damage caused by swallowing multiple magnets

Abstract

Swallowing multiple magnets is not uncommon worldwide and it frequently leads to serious consequences. However, most patients fail to receive timely and correct diagnosis and treatment. A literature search was performed to establish an algorithm for these accidents by the authors to identify relevant articles published from June 1987 to October 2010 in Google, Medline, ISI Web of Knowledge Ovid, CNKI, Korea Med and library document delivery, using search terms “magnet ingestion, ” “fistula, ” and “perforation. ” A total of 149 patients with ingestion of magnetic foreign bodies from 20 countries and areas were identified. 22 of them were companioned with neurological and psychiatric disorders. Swallowing magnets occurred throughout childhood and adolescent, mostly ranging 2 to 4 years in age. Various gastrointestinal damages such as necrosis and intestinal perforation or fistula were encountered. Damage from swallowing multiple magnets carries a significant risk of morbidity and even mortality throughout childhood to adolescent worldwide. Older children and adults with neurological and psychiatric problems may be at high risk for such accidents. Early intervention is crucial.

Keywords

magnet / ingestion / fistula / perforation

References

[1] Ginsberg GG. Management of ingested foreign objects and food bolus impactions. Gastrointest Endosc 1995; 41(1): 33–38

[2] Lee SK, Beck NS, Kim HH. Mischievous magnets: unexpected health hazard in children. J Pediatr Surg 1996; 31(12): 1694–1695

[3] Kay M, Wyllie R. Pediatric foreign bodies and their management. Curr Gastroenterol Rep 2005; 7(3): 212–218

[4] Kuzon WM Jr, McFadyen CA, Moffat FL. Unusual gastric foreign body: a case report. Can J Surg 1988; 31(6): 413–417

[5] Chung JH, Kim JS, Song YT. Small bowel complication caused by magnetic foreign body ingestion of children: two case reports. J Pediatr Surg 2003; 38(10): 1548–1550

[6] Tay ET, Weinberg G, Levin TL. Ingested magnets: the force within. Pediatr Emerg Care 2004; 20(7): 466–467

[7] Kirrane BM, Nelson LS, Hoffman RS. Massive strontium ferrite ingestion without acute toxicity. Basic Clin Pharmacol Toxicol 2006; 99(5): 358–359

[8] Baliga SK, Hussain D, Sarfraz SL, Hartung RU. Magnetic attraction: dual complications in a single case. J Coll Physicians Surg Pak 2008; 18(7): 440–441

[9] Nishi Y, Sasajima K, Matsutani T, Miyamoto M, Maruyama H, Yokoyama T, Yanagi K, Matsuda A, Kashiwabara M, Tajiri T. Intestinal fistulas caused by ingestion of magnets in an adult. Jpn J Gastroenterol Surg 2008; 41(12): 2069–2074 (in Japanese)

[10] Rashid F, Davies L, Iftikhar SY. Magnetised intragastric foreign body collection and autism: an advice for carers and literature review. Autism 2010; 14(2): 139–145

[11] Oestreich AE. Worldwide survey of damage from swallowing multiple magnets. Pediatr Radiol 2009; 39(2): 142–147

[12] Tachecí I, Králová M, Osoha V, Bureš J. Ingestion of multiple magnets in a child with Down syndrome. Folia Gastroenterol Hepatol 2006; 4(4): 171–174

[13] Midgett J, Inkster S, Gilchrist J. Gastrointestinal injuries from magnet ingestion in children—United States, 2003–2006. MMWR Morb Mortal Wkly Rep 2006; 55(48): 1296–1300

[14] Kabre R, Chin A, Rowell E, Browne M, Barsness KA, Luck S, Jona J. Hazardous complications of multiple ingested magnets: report of four cases. Eur J Pediatr Surg 2009; 19(3): 187–189

[15] Nagaraj HS, Sunil I. Multiple foreign body ingestion and ileal perforation. Pediatr Surg Int 2005; 21(9): 718–720

[16] de la Fuente SG, Rice HE. Ingestion of unusual foreign bodies and malrotation: a “perfect storm”. Pediatr Surg Int 2006; 22(10): 869–872

[17] Dutta S, Barzin A. Multiple magnet ingestion as a source of severe gastrointestinal complications requiring surgical intervention. Arch Pediatr Adolesc Med 2008; 162(2): 123–125

[18] Haraguchi M, Matsuo S, Tokail H, Azuma T, Yamaguchi S, Dateki S, Fukahori K, Kanematsu T. Surgical intervention for the ingestion of multiple magnets by children. J Clin Gastroenterol 2004; 38(10): 915–916

[19] Liu S, de Blacam C, Lim FY, Mattei P, Mamula P. Magnetic foreign body ingestions leading to duodenocolonic fistula. J Pediatr Gastroenterol Nutr 2005; 41(5): 670–672

[20] Mok E, Bazan HA, Herron DM. An unusual source of abdominal pain after adjustable gastric banding. Surg Obes Relat Dis 2005; 1(6): 584–587

[21] Oestreich AE. Multiple magnet ingestion alert. Radiology 2004; 233(2): 615

[22] Oestreich AE. Danger of multiple magnets beyond the stomach in children. J Natl Med Assoc 2006; 98(2): 277–279

[23] Hong SG, Chung JH, Song YT. Small bowel complication due to magnetic foreign body ingestion in childhood. J Korean Surg Soc 2001; 61(2): 224–226

[24] Encinas JL, García-Bermejo C, Andrés AM, Burgos L, Hernández P, Tovar JA.Multiple intestinal perforations due to ingestion of magnetized pieces of a toy. An Pediatr (Barc) 2005; 63(5): 457–458 (in Spanish)

[25] Starke L. Easy removal of nasal magnets. Pediatr Emerg Care 2005; 21(9): 598–599

[26] Cortés C, Silva C. Accidental ingestion of magnets in children. Report of three cases. Rev Med Chil 2006; 134(10): 1315–1319 (in Spanish)

[27] Gregori D, Morra B. Foreign body injuries in children involving magnets:an epidemiological perspective suggesting the need for an immediate awareness of the medical community. I2C Research Group Working Papers, 03/2007. 2007.www.i2crg.org

[28] Schierling S, Snyder SK, Custer M, Pohl JF, Easley D. Magnet ingestion. J Pediatr 2008; 152(2): 294–294.e1.

[29] Consumer Product Safety Commission. Child’s death prompts replacement program of magnetic building sets. Washington, DC: Consumer Product Safety Commission, 2006. Available at http://www.cpsc.gov/cpscpub/prerel/prhtml06/06127.html (Accessed on Mar 31, 2006)

[30] Ilçe Z, Samsum H, Mammadov E, Celayir S. Intestinal volvulus and perforation caused by multiple magnet ingestion: report of a case. Surg Today 2007; 37(1): 50–52

[31] Jamshidi R, Harrison M. A stronger understanding of magnet-ingestion injuries. Arch Pediatr Adolesc Med 2008; 162(9): 900, author reply 900

[32] Chang YS, Song JY, Choi SI. Ileal perforation caused by ingestion of multiple magnets. J Korean Surg Soc 2009; 76(4): 270–272

[33] 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

[34] McCormick S, Brennan P, Yassa J, Shawis R. Children and mini-magnets: an almost fatal attraction. Emerg Med J 2002; 19(1): 71–73

[35] Berg DA, Tynan MG, Grewal H. Magnets in the stomach. J Pediatr Surg 2006; 41(5): 1037–1039

[36] Hwang JB, Park MH, Choi SO, Park WH, Kim AS. How strong construction toy magnets are! A gastro-gastro-duodenal fistula formation. J Pediatr Gastroenterol Nutr 2007; 44(2): 291–292

[37] Oestreich AE. The usefulness of magnification in postgastric magnetopathy. Pediatr Radiol 2007; 37(12): 1268–1269

[38] Pryor HI 2nd, Lange PA, Bader A, Gilbert J, Newman K. Multiple magnetic foreign body ingestion: a surgical problem. J Am Coll Surg 2007; 205(1): 182–186

[39] Moussouras N, Pratt CA, Neilson I. Magnetic toy ingestion: surgical implications. Alaska Med 2008; 49(4): 117–119

[40] Zampieri N, Consolaro G, Ottolenghi A, Camoglio FS. Unusual diagnosis of multiple magnet ingestion R1. Pediatr Int 2010; 52(1): e14–e16

[41] Fenton SJ, Torgenson M, Holsti M, Black RE. Magnetic attraction leading to a small bowel obstruction in a child. Pediatr Surg Int 2007; 23(12): 1245–1247

[42] Ohno Y, Yoneda A, Enjoji A, Furui J, Kanematsu T. Gastroduodenal fistula caused by ingested magnets. Gastrointest Endosc 2005; 61(1): 109–110

[43] Cauchi JA, Shawis RN. Multiple magnet ingestion and gastrointestinal morbidity. Arch Dis Child 2002; 87(6): 539–540

[44] Brown DJ. Small bowel perforation caused by multiple magnet ingestion. J Emerg Med 2010; 39(4): 497–498

[45] Lee WH, Min YD, Moon KR. A case of gastroduodenal fistula caused by ingested magnetic foreign bodies. Korean J Pediatr Gastroenterol Nutr 2008; 11(1): 84–88

[46] 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(5): 511–516

[47] Shah SK, Tieu KK, Tsao K. Intestinal complications of magnet ingestion in children from the pediatric surgery perspective. Eur J Pediatr Surg 2009; 19(5): 334–337

[48] Wildhaber BE, Le Coultre C, Genin B. Ingestion of magnets: innocent in solitude, harmful in groups. J Pediatr Surg 2005; 40(10): e33–e35

[49] Butterworth J, Feltis B. Toy magnet ingestion in children: revising the algorithm. J Pediatr Surg 2007; 42(12): e3–e5

[50] Kircher MF, Milla S, Callahan MJ. Ingestion of magnetic foreign bodies causing multiple bowel perforations. Pediatr Radiol 2007; 37(9): 933–936

[51] Saeed A, Johal NS, Aslam A, Brain J, Fitzgerald RJ. Attraction problems following magnet ingestion. Ann R Coll Surg Engl 2009; 91(5): W10–W12

[52] Lin MT, Yeung CY, Lee HC, Sheu JC, Wang NL, Lee KS. Management of foreign body ingestion in children: experience with 42 cases. Acta Paediatr Taiwan 2003; 44(5): 269–273

[53] Wang Q. Two cases of children’s magnetic foreign body. Chin J Gen Surg (Zhonghua Pu Tong Wai Ke Za Zhi) 2008; 23(9): 731 (in Chinese)

[54] Robinson AJ, Bingham J, Thompson RL. Magnet induced perforated appendicitis and ileo-caecal fistula formation. Ulster Med J 2009; 78(1): 4–6

[55] Ahmed AM, Hassab MH, Al-Hussaini AA, Al-Tokhais TI. Magnetic toy ingestion leading to jejunocecal fistula in a child. Saudi Med J 2010; 31(4): 442–444

[56] Pae SY, Moon KR, Park HS, Lee SS. A case of septal perforation reconstructed with alloderm interposition graft resulted from magnetic nasal foreign bodies. Korean J Otorhinolaryngol-Head Neck Surg 2009; 52(3): 262–265

[57] Park JH, Park CH, Park JH, Lee SJ, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ. Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal. Korean J Gastroenterol 2004; 43(4): 226–233 (in Korean)

[58] Hernández Anselmi E, Gutiérrez San Román C, Barrios Fontoba JE, Ayuso González L, Valdés Dieguez E, Lluna González J, Roca Molla A, García-Sala Viguer C, Gómez Montes J, Cortina Orts H. Intestinal perforation caused by magnetic toys. J Pediatr Surg 2007; 42(3): E13–E16

[59] Nui A, Hirama T, Katsuramaki T, Maeda T, Meguro M, Nagayama M, Matsuno T, Mizumoto T, Hirata K. An intestinal volvulus caused by multiple magnet ingestion: an unexpected risk in children. J Pediatr Surg 2005; 40(9): e9–e11

[60] Kubota Y, Tokiwa K, Tanaka S, Iwai N. Intestinal obstruction in an infant due to magnet ingestion. Eur J Pediatr Surg 1995; 5(2): 119–120

[61] Durko A, Czkwianianc E, Bak-Romaniszyn L, Malecka-Panas E. Accidental ingestion of two magnets—aggresive or prolonged approach? Rev Med Chil 2007; 22(131): 416–418 (in Polish)

[62] Attila GD. Hazards of ingested magnets. J Lanc Gen Hosp 2009; 4(3): 90–92

[63] Sahin C, Alver D, Gulcin N, Kurt G, Celayir AC. A rare cause of intestinal perforation: ingestion of magnet. World J Pediatr 2010; 6(4): 369–371

[64] Palanivelu C, Rangarajan M, Rajapandian S, Vittal SK, Maheshkumaar GS. Laparoscopic retrieval of “stubborn” foreign bodies in the foregut: a case report and literature survey. Surg Laparosc Endosc Percutan Tech 2007;17(6):528–532

[65] Uchida K, Otake K, Iwata T, Watanabe H, Inoue M, Hatada T, Kusunoki M. Ingestion of multiple magnets: hazardous foreign bodies for children. Pediatr Radiol 2006; 36(3): 263–264

[66] Wong HH, Phillips BA. Opposites attract: a case of magnet ingestion. CJEM 2009; 11(5): 493–495

[67] Magnet Sales and Manufacturing Inc. 2000. Available at: http://www.magnetsales.com (Accessed on Dec 16, 2008)

[68] Ratterman R, Secrest J, Norwood B, Ch’ien AP. Magnet therapy: what’s the attraction?J Am Acad Nurse Pract 2002; 14(8): 347–353

[69] Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, Mallery JS, Raddawi HM, Vargo JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002; 55(7): 802–806

[70] Ayantunde AA, Oke T. A review of gastrointestinal foreign bodies. Int J Clin Pract 2006; 60(6): 735–739

[71] Wong KK, Fang CX, Tam PK. Selective upper endoscopy for foreign body ingestion in children: an evaluation of management protocol after 282 cases. J Pediatr Surg 2006; 41(12): 2016–2018

[72] 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(4): 367–374

[73] Proano JM, Palmer JS. Erosion of magnets into the scrotum in the pediatric patient. Urology 2005; 66(5): 1109

[74] Motwane S A, Ahuja A S, Mahajan M, Kothari S, Kazi S, Balasubramanium S. Traumatic cataract with intraocular foreign body. J Bombay Ophthalmol Assoc 2000; 10(3): 165–167

[75] Malla OKS A KS. Management of magenetic intraocular foreign body. JNMA J Nepal Med Assoc 2003; 42: 300–301

[76] Anderson RC, Walker ML, Viner JM, Kestle JR. Adjustment and malfunction of a programmable valve after exposure to toy magnets. Case report. J Neurosurg 2004; 101(Suppl 2): 222–225

[77] Guilfoyle MR, Fernandes H, Price S. In vivo alteration of Strata valve setting by vagus nerve stimulator-activating magnet. Br J Neurosurg 2007; 21(1): 41–42

[78] Zuzak TJ, Balmer B, Schmidig D, Boltshauser E, Grotzer MA. Magnetic toys: forbidden for pediatric patients with certain programmable shunt valves? Childs Nerv Syst 2009; 25(2): 161–164

[79] Stepanov EA, Vasilyev GS, Nikolaev VV. Treatment of intestinal fistulas in children by forming a bypass anastomosis by means of magnetic devices. Khirurgiya 1992; 11: 93–95

[80] Jaffe RB, Corneli HM. Fluoroscopic removal of ingested alkaline batteries. Radiology 1984; 150(2): 585–586

[81] Ito Y, Ihara N, Sohma S. Magnetic removal of alkaline batteries from the stomach. J Pediatr Surg 1985; 20(3): 250–251

[82] Volle E, Hanel D, Beyer P, Kaufmann HJ. Ingested foreign bodies: removal by magnet. Radiology 1986; 160(2): 407–409

[83] Volle E, Beyer P, Kaufmann H J. Therapeutic approach to ingested buttontype batteries Magnetic removal of ingested Button-type batteries. Pediatr Radiol 1989; 19: 114–118

[84] Towbin RB, Dunbar JS, Rice S. Magnetic catheter for removal of magnetic foreign bodies. AJR Am J Roentgenol 1990; 154(1): 149–150

[85] Myers C, Yellen B, Evans J, DeMaria E, Pryor A. Using external magnet guidance and endoscopically placed magnets to create suture-free gastro-enteral anastomoses. Surg Endosc 2010; 24(5): 1104–1109

[86] Li J, Lü Y, Qu B, Zhang Z, Liu C, Shi Y, Wang B. Application of a new type of sutureless magnetic biliary-enteric anastomosis stent for one-stage reconstruction of the biliary-enteric continuity after acute bile duct injury: an experimental study. J Surg Res 2008; 148(2): 136–142

[87] Suyama K, Takamori H, Yamanouchi E, Tanaka H, Sakamoto Y, Ikuta Y, Maki Y, Sakurai K, Hirota M, Baba H. Recanalization of obstructed choledochojejunostomy using the magnet compression anastomosis technique. Am J Gastroenterol 2010; 105(1): 230– 231

Acknowledgements

This work was supported by the National Natural Science Foundation of China (Grant No. 30830099).

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