Patient: A 10 year old female is brought to the ED after swallowing 2 beads (see image). Based on the findings, what are your concerns and what is the disposition?
Answer: Multiple Magnet Ingestion
The mother was eventually able to produce the magnetic beads ingested at home 2 hours prior to presentation
The ingestion of multiple magnets is a medical emergency. If the 2 magnets separate and reconnect it can lead to:
- pressure necrosis
- bowel perforation
- fistula formation
- and/or bowel obstruction secondary to kinking, inflammatory reaction, and/or internal herniation
Patients with a multiple magnet ingestion should be taken emergently to the OR for endoscopic evaluation.
If the magnets have passed the pylorus, conservative management with laxatives and serial X-rays may be performed, however if their position becomes fixed on serial imaging then an emergent laparotomy may need to be performed for the removal of the FBs before the symptoms and signs occur.
Bottom line: Patients presenting with a multiple magnet ingestion need to be admitted regardless of the FB location. Consult GI and pediatric surgery early, since prompt removal can prevent devastating outcomes. Single magnet ingestions can be managed conservatively with serial exams and imaging.
Reference:
Alzaham AM et al, Ingested magnets and gastrointestinal complications. Journal of Paediatrics and Child Health; 43 (2007) 497–498.
