Abstract
Background:
Children are attracted toward magnets and magnetic toys, but ingestion may cause morbidity, particularly if consumed at separate time intervals. Ingestion of multiple magnets that pass into the intestine may present with an acute abdomen from perforation or fistulization. When multiple magnets are identified in the stomach, expedient endoscopic removal is recommended in case another unrecognized ingestion occurs at a later time.
Case 1:
A 3-year-old boy ingested two neodymium magnets. These powerful magnets attract with up to 6 pounds of pressure. A radiograph confirmed they were in the stomach.
Procedure:
Under general anesthesia, an endoscope was passed. The pacemaker magnet was applied to the anterior abdominal wall. The magnets were easily observed, stabilized, and removed with an endoscopic stone extractor. The operative time was 8 minutes.
Case 2:
A 5-year-old boy ingested 11, 3-mm diameter, rare earth magnets (buckyballs). He presented to the emergency department. Radiographs confirmed the magnets were in the stomach. The pediatric gastroenterologist attempted removal, but after 90 minutes, only 1 of 11 was effectively removed. Pediatric surgery was contacted to remove the remaining 10 magnets.
Procedure:
Under general anesthesia, the endoscope was passed into the stomach and the magnets were observed. A pacemaker magnet was applied to the anterior abdominal wall. The chain of 10 magnets was stabilized anteriorly and observed. An endoscopic net retrieval bag was utilized to remove all 10 “buckyballs” in one attempt. The operative time was 9 minutes. A postprocedure radiograph confirmed all magnets were removed. Both children were discharged home from the recovery room without complications.
Conclusion:
A pacemaker magnet is widely available in the operating room. When a child presents with ingested magnets in the stomach, the pacemaker magnet stabilizes the foreign bodies against the anterior stomach wall. It allows efficient, expedient removal of multiple ingested magnets. Retrieval instruments such as the endoscopic stone extractor or a mesh endoscopic retrieval bag provide versatility when removing ingested magnets.
All authors participated in (1) the conception and design of the study, acquisition of data, analysis and interpretation of data, (2) drafting the video or revising it critically for important intellectual content, and (3) final approval of the version to be submitted.
No competing financial interests exist.
Runtime of video: 4 mins 45 secs
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