Laparoscopic Approach for the Management of Ingested Magnets

Abstract

Introduction:

We present a case of a 14-year-old healthy girl who ingested two magnets few days before her emergency department visit. She complained of right upper quadrant (RUQ) pain that had started 6 hours prior, which was becoming more localized, constant, and worsening in severity. She did, however, complain of nausea and vomiting. She was hemodynamically stable and afebrile and had RUQ tenderness without peritoneal signs. She had a significant leukocytosis of 14,000 WBC. An abdominal X-ray revealed two magnets in the RUQ. Their position was not clear even on CT imaging due to associated artifact. The position of magnets on a 4-hour serial X-ray failed to progress and a decision was made to take her to the operating room. She had a diagnostic laparoscopy. Magnetic attraction was noted around the hepatic flexure where one of the magnets was present. The other magnet was present in the duodenum causing it to adhere to the colon almost causing a coloduodenal fistula. A colotomy was performed and the first magnet was removed. The colotomy was repaired with a 2.0 Vicryl, and the incidental appendectomy was performed to exclude potential confusion in the future. The second magnet was left and serial images showed its passage through the intestine.

Materials and Methods:

A case report and a video presentation.

Results:

Full recovery.

Conclusion:

Early surgical intervention after ingestion of magnets is very important to prevent bowel perforation. This intervention can be easily performed laparoscopically with minimal morbidity.

No competing financial interest exist.

Runtime of video: 4 mins