title: Ingestion of magnetic toys: report of serious complications requiring surgical intervention and a proposed management algorithm.
abstract: BACKGROUND
  Increasing popularity of strong magnets as toys has led to their ingestion by children, putting them at risk of potentially harmful gastrointestinal tract injuries.
  
  
  OBJECTIVE
  To heighten physician awareness of the potential complications of magnetic foreign body ingestion, and to provide an updated algorithm for management of a patient who is suspected to have ingested magnets.
  
  
  METHODS
  A retrospective review of magnet ingestions treated over a two-year period at our institutions in the Southern California Permanente Medical Group. Data including patient demographics, clinical information, radiologic images, and surgical records were used to propose a management strategy.
  
  
  RESULTS
  Five patients, aged 15 months to 18 years, presented with abdominal symptoms after magnet ingestion. Four of the 5 patients suffered serious complications, including bowel necrosis, perforation, fistula formation, and obstruction. All patients were successfully treated with laparoscopic-assisted exploration with or without endoscopy. Total days in the hospital averaged 5.2 days (range = 3 to 9 days). Average time to discharge following surgery was 4 days (range = 2 to 7 days). Ex vivo experimentation with toy magnetic beads were performed to reveal characteristics of the magnetic toys.
  
  
  CONCLUSIONS
  Physicians should have a heightened sense of caution when treating a patient in whom magnetic foreign body ingestion is suspected, because of the potential gastrointestinal complications. An updated management strategy is proposed that both prevents delays in surgical care and avoids unnecessary surgical exploration.
authors.affiliation: Los Angeles Medical Center in California, USA. jerry.y.tsai@kp.org
authors.forename: Jerry
authors.initials: J
authors.lastname: Tsai
authors.forename: Donald B
authors.initials: DB
authors.lastname: Shaul
authors.forename: Roman M
authors.initials: RM
authors.lastname: Sydorak
authors.forename: Stanley T
authors.initials: ST
authors.lastname: Lau
authors.forename: Yasir
authors.initials: Y
authors.lastname: Akmal
authors.forename: Karen
authors.initials: K
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004435:Eating; D005260:Female; D005547:Foreign Bodies / Q000209:etiology* / Q000601:surgery; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D059346:Magnets; D008297:Male; D010988:Play and Playthings; D012189:Retrospective Studies