Techniques for Management of Multiple Ingested Magnets

Abstract

Introduction:

Foreign body ingestions are a common problem managed by pediatric surgeons. Although the majority of ingested objects lead to no significant clinical consequence and often do not require intervention, button batteries and magnets pose a more serious threat to patients. Magnet ingestions, particularly with strong rare earth magnets and when multiple magnets or additional metallic foreign bodies are swallowed, can connect multiple loops of the gastrointestinal tract together and cause pressure necrosis, obstruction, and perforation. ^{1 –4} The removal of multiple ingested magnets can present diagnostic and therapeutic challenges caused by the strong attractive forces between the magnets that can counteract standard removal methods. In this video case report, we describe the endoscopic evaluation and removal of multiple ingested magnets that had failed conventional removal methods.

Materials and Methods:

The patient was a healthy 20-month-old girl child who ingested five small magnets from a toy. She did not have any symptoms but was brought to the Emergency Department for evaluation after her mother noted the magnets missing. After an initial period of nonoperative management, further imaging confirmed that the magnets were in the stomach and had failed to progress. The patient was taken for flexible upper endoscopy where two groups of magnets were noted along the lesser curvature with a prepyloric antral fold stuck between the groups of magnets. Multiple attempts to remove the magnets were attempted with standard metal instruments but were unsuccessful because of the instrument becoming magnetized and sticking to the magnets. After consultation with an adult surgeon with fellowship training in advanced endoluminal surgery, a nylon loop ligating device was used to remove the magnets. ⁵ This device is typically used for ligation of polyps before polypectomy. Finally, the duodenum was examined for evidence of a gastroduodenal fistula that was negative and the mucosal defects were examined using a distal cap attachment. Intact submucosa was noted under both mucosal erosions without evidence of perforation or bleeding and no clips were placed.

Results:

The patient tolerated a diet later that day and was discharged to home. No complications have been reported.

Conclusion:

This video highlights the importance of multidisciplinary care between adult and children's surgeons. In addition, the video describes available techniques and tools for use in such difficult cases, which enable magnet removal and thorough endoscopic evaluation for complications of the ingestion.

C.G.D., A.P.K., A.T.L., and C.N.G.: No competing financial interests exist. E.M.P.: Speaking/teaching: Cook Biotech, Inc., C.R. Bard, Inc., Boston Scientific Corp. Ovesco; research support: C.R. Bard, Inc.; consultant: Boston Scientific Corp., Actuated Medical, Inc., Medtronic, Baxter, Surgimatrix, CMR Surgical; royalties: UpToDate, Inc., Springer.

Runtime of video:

5 mins 00 secs