UMEM Educational Pearls

Kids eat everything (except perhaps carefully prepared and balanced meals). While button battery ingestions are feared, there is more to worry about. Magnet ingestions – especially rare earth metal magnet ingestions – can lead to high morbidity and mortality.

When more than one magnet (or a magnet and another metallic object) are ingested, they can become stuck together through walls in the GI tract, creating risk for obstruction, erosion, fistula formation, and perforation. Sharp metallic foreign objects can be particularly dangerous as they can do much damage while being moved around by the magnet.  

If there is concern for magnet ingestion, care should be taken to try to determine the number ingested (if parents have the magnets, you can compare the size of an object on xray to the size of the magnets as it can otherwise sometimes be difficult to differentiate if it is one magnet or more than one stuck together).  

Higher risk features of ingestion include: 

  • Ingestion of a magnet and a sharp metallic object
  • Higher number of magnets ingested
  • A longer interval over which the magnets were ingested
  • Multiple magnets in the esophagus (raises concern for concomitant aspiration)

 

Ingestions should prompt consultation with pediatric GI and surgery when isolated as many will require either endoscopic or surgical removal. This may include need for referral and transfer.  

 

References

Nugud AA, Tzivinikos C, Assa A, et al. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. Journal of pediatric gastroenterology and nutrition. 2023;76(4):523-532.