Prevalence, clinical features and management of pediatric magnetic foreign body ingestions.
BACKGROUND
Foreign body (FB) ingestions are frequent in children. Whereas the majority of FBs pass spontaneously through the gastrointestinal tract, ingestion of magnetic FBs pose a particular risk for obstruction due to proximate attraction through the intestinal wall.


OBJECTIVE
We aimed to identify the prevalence, clinical presentation, and management of magnetic FB ingestions at our tertiary care institution.


METHODS
We performed a retrospective chart review of medical records of patients presenting to the pediatric Emergency Department (ED) or admitted to the hospital with FB ingestions from June 2003-July 2009. From those cases, patients with magnetic FB ingestions were identified.


RESULTS
During the study period, 337,839 patients presented to the ED; 38 cases of magnetic FB ingestion were identified (prevalence 0.01%). Abdominal radiography was obtained in all cases. Ingestion of a single magnet occurred in 30 of 38 cases (79%). Of those, 4 patients underwent endoscopic removal due to signs of FB impaction in the esophagus or pylorus; no complications were noted. Ingestion of multiple magnets (range 2-6) occurred in 8 of 38 cases. Four of the 8 patients with multiple magnetic FBs (50%) presented with signs of peritonitis and required operative repair of multiple intestinal perforations. No deaths were identified.


CONCLUSIONS
Although ingestion of a single magnetic FB may, in most cases, be managed as a simple FB ingestion, the ingestion of multiple magnetic FB is associated with a high risk of complication and requires aggressive management. We propose an algorithm for management of children with magnetic FB ingestions.
Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania 152224, USA.
Melissa M
MM
Tavarez
Richard A
RA
Saladino
Barbara A
BA
Gaines
Mioara D
MD
Manole
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000453:epidemiology* / Q000628:therapy; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D059346:Magnets / Q000633:toxicity*; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies