title: Magnetic attraction leading to a small bowel obstruction in a child.
abstract: Foreign body ingestion in small children is common yet only 1% of cases require operative management of associated complications (Arana et al. in Eur J Pediatr 160:468-472, 2001). A 6-year-old boy was referred to our institution with a 12 h history of abdominal pain. This pain was diffuse and crampy in nature and associated with multiple episodes of non-bilious, non-bloody emesis. On evaluation he was stable and his abdomen demonstrated slight distention and tenderness without peritoneal signs. Plain abdominal radiographs demonstrated some distended loops of small bowel and a radio-opaque foreign object within the mid-abdomen. A small bowel obstruction secondary to foreign body ingestion was diagnosed and an emergent laparotomy performed. Upon exploration, a transition zone was noted near the ileocecal valve. Further exploration revealed the obstruction to be caused secondary to the apposition of two small (8 mm) magnets, one in the proximal ileum and the other near the ileocecal valve, resulting in an internal hernia. The magnets were easily separated relieving the obstruction and both were removed via two small bowel enterotomies. After being presented with the magnets, his parents suspected that they came from the clothes of a Polly Pocket (Mattel, Inc., El Segundo, CA) doll. The patient had an uneventful post-operative course and was discharged to home on the second post-operative day. This case demonstrates the complications that may occur with multiple magnet ingestion. It highlights the need for close observation and early surgical intervention in children with a suspected history of foreign body ingestion, a clinical picture of gastrointestinal distress, and radiographic evidence of a radio-opaque foreign object.
authors: Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA. stephen.fenton@hsc.utah.edu
authors: Stephen J
authors: SJ
authors: Fenton
authors: Marcus
authors: M
authors: Torgenson
authors: Maija
authors: M
authors: Holsti
authors: Richard E
authors: RE
authors: Black
mesh_terms: D002648:Child; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007421:Intestine, Small / Q000293:injuries*; D007813:Laparotomy / Q000379:methods*; D008280:Magnetics / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D011860:Radiography, Abdominal
references: J Emerg Med. 1998 Jan-Feb;16(1):21-6
references: 9472755
references: Surg Today. 1995;25(6):552-3
references: 7579965
references: J Pediatr Surg. 2005 Sep;40(9):e9-11
references: 16150334
references: Pediatr Emerg Care. 2004 Jul;20(7):466-7
references: 15232250
references: J Pediatr Surg. 2003 Oct;38(10 ):1548-50
references: 14577087
references: Pediatr Radiol. 2006 Mar;36(3):263-4
references: 16317540
references: Eur J Pediatr Surg. 1995 Apr;5(2):119-20
references: 7612582
references: J Pediatr Surg. 2005 Oct;40(10):e33-5
references: 16226973
references: Eur J Pediatr. 2001 Aug;160(8):468-72
references: 11548183
references: Arch Dis Child. 2002 Dec;87(6):539-40
references: 12456561
references: Pediatrics. 1992 Apr;89(4 Pt 2):747-57
references: 1557273
references: J Pediatr Surg. 1996 Dec;31(12):1694-5
references: 8986992
references: Pediatrics. 1985 Mar;75(3):469-76
references: 3883304