P038: "I THINK SHE SWALLOWED SOMETHING" –UNDERSTANDING THE RISKS AND COMPLICATIONS OF MAGNET INGESTION
A Valerio, MD1; A Kurian, MD2; M Garcia-Otero, CRNA, PhD2; M Martini, MD1; A Hogan, MD1; L I Rodriguez, MD1; 1University of Miami. Jackson Memorial Hospital; 2Jackson Memorial Hospital
Pediatric foreign body ingestion represent in a highly variable manner. Increasing prevalence of smaller, technologically advanced toys in the household has resulted in an increased exposure to powerful magnets that carry a high incidence of morbidity and mortality. The propulsive force of peristalsis may result in detachment of the magnetic objects from each other. After a while the attractive magnetic force reattaches the objects together resulting in entrapment of mucus membrane or the whole thickness of bowel wall in between the magnetic objects leading to necrosis, perforation and fistula formation. Among all documented cases of foreign body ingestion, the incidence of magnet was approximately 3.06 cases per 100,000 people, with 80% of cases involving children between 6m and 3 yr.
We present a case of a 17 m girl, previously healthy, who over two days became more lethargic, and decreased appetite. Taken to an outside hospital which shown in KUB, foreign bodies recognized as magnet “buckyballs” (16 in total). Patient was then transferred to our center and after GI and pediatric surgery consulted, decision to take to OR for EGD and possible ELap. Patient was hemodynamically stable, and after a smooth induction and intubation, EGD was performed and only 8/16 magnets were found in the 2nd portion of the duodenum, with one end of the string of magnets lodged in the mucosa. Decision made to do Exploratory Laparotomy, were a perforation was found in the 2nd portion of the duodenum and the ascending colon. All magnets were removed and both perforations repaired, patient extubated at the end of the case. Remained in PICU for 2 days and then transferred to the floor for 1 week of bowel rest, with later discharge home.
Typical symptoms include stridor, drooling, fussiness, chest pain, fever, feeding refusal. Most children remain asymptomatic, unless there is a complication. Patient can also have nonspecific signs that may be misconstrued as a gastrointestinal or respiratory infection. Oftentimes present having been witnessed by parents.
The initial step is to ascertain the diagnosis of magnet ingestion in a child presenting with vomiting and abdominal pain, in an environment wherein small magnets are present. Once is confirmed on x-ray, the next step is to determine whether only a single vs multiple magnet was ingested with multiples radiologic views. If a child is suspected of swallowing multiple magnets, it is necessary to determine the location. If magnets are present in the stomach and esophagus, endoscopic removal could be attempted. In children without severe symptoms in whom magnets are suspected to have advanced beyond the stomach, without evidence of obstruction and/or perforation, serial plain radiographs should be obtained while awaiting magnet migration. Following radiographic evidence of magnet migration, children can be discharged with appropriate education and close monitoring at outpatient visits. However, surgical intervention is warranted if magnet migration does not occur.