Associate Pediatric Surgery King Abdulla bin Abdul-Aziz

University Hospital _ PNU

Magnetic Toys Ingestion In Children

Dr. Ali M Ahmad Consultant Pediatric Surgery;

MBBCh, MS, MD, MRCS-Ed, EBPS

FBs ingestion is a common clinical problem in young children.

Fortunately, most FBs usually cause no harm and spontaneously come out of the rectum without treatment.

Introduction

The incidence of FB ingestion is > 100,000 patients annually in the United States & > 80% of these occur in the pediatric population with 98% of these being accidental.

The majority of FBs that reach the stomach will pass through the GI spontaneously with no consequence.

Endoscopic retrieval is required in 10% to 20%.

< 1% will require surgical intervention

Review [1, 2].

FBs that require endoscopic or

surgical removal are

Large enough to cause obstructionSharp edgesTransmural injury by caustic or mechanical forces.

Review [3]

The Aim Highlights this serious problem & its

management

Two cases with MM toys ingestions

A 5-year-old girl

History of ingestion of a piece of magnetic toy

She visited the ER many times

Based on stable clinical condition & the x-ray findings the patient reassured & discharge home ; that the FB will pass spontaneously.

Three months later she presented to our ER

with acute abdominal pain

Repeated x-ray confirmed the presence of two FBs.

Colonoscopy 26-08-2009 Shows sever inflammation

Jejuno-cecal fistula at 40 cm from du- jejunal junction

Two ovals powerful magnetic toys {measure 3.8 x 1.3}

A 2-year-old girl.

with history of ingestion of a pieces of magnetic toys.

She visited the ER many times.

Based on stable here benign clinical condition ;the patient discharged home with reassurance that the object would pass spontaneously.

Two months later She presented to our ER with acute abdominal

pain.

Laparotomy

Uneventful postoperative

DC home 5th & 7th POD

Ingestion of magnets by children has recently come to greater attention due to

The death of a 2-year-old boy in Washington State, USA after swallowing pieces of the

magnetized playset Magnetix1 (Rose Art Industries Inc., Livingston, NJ)

Review [4]

Recent improvements in manufacturing processes

have made Small, Powerful Magnets

Inexpensive & Readily Available

increasing the potential for exposure of children to

magnets in toys and other products.

Review [5].

Complications associated with

Magnetic FBs ingestions are still underestimated

Attraction of two or more magnets across the walls of multiple loops of bowel

causes ischemia and necrosis that lead to

Obstruction, Ulceration, Fistula, Perforation, Volvulus and Strangulation

Review [6, 7]

If the ingested FB is revealed on a plane radiographand the position becomes fixed on serial radiographs

There should be Suspicion of ingesting multiple magnets

Review [9]

Plain radiography lack the sensitivity to determine the multiplicity of FBs.

Review [8]

IF THE INGESTED MULTIPLE MAGNETS

Pass the pylorus on the abdominal radiography

Should be removed immediately by laparotomy before any symptoms or complications occur

Review [10].

MM ingestion can lead to serious GI complications

MM ingestion, compared to a single magnet, is a distinct clinical situation that needs to be managed differently.

Think for MM if FBs fixed in position on X-ray

Conclusions

Surgery is Recommended if MM passed the pylorus

Awareness among; Clinicians , public & toys manufacturing about this health hazards may improve the outcome.

Conclusions

1. Butterworth J, Feltis B. Toy magnet ingestion in children: revising the algorithm. J Pediatr Surg 2007; 42, E3–E5.2. Alzahem A, Soundappan S, Jefferies H, Cass D. Ingested magnets and gastrointestinal complications. Journal of

Paediatrics and Child Health 2007; 43, 497–8.3. Pryor H, Lange P, Bader A, Gilbert J, Newman K. Multiple Magnetic Foreign Body Ingestion: A Surgical Problem. J

Am Coll Surg 2007; 205, 182-6. 4. Fenton S, Torgenson M, Holsti M, Black R. Magnetic attraction leading to a small bowel obstruction in a child.

Pediatr Surg Int 2007; 23, 1245–7.5. McCormick S, Brennan P, Yassa J, Shawis R. Children and mini-magnets: an almost fatal attraction. Emerg Med J

2002; 19, 71–3.6. Robinson A, Bingham J, Thompson R. Magnet induced perforated appendicitis and ileo-caecal fistula formation.

Ulster Med J 2009; 78 (1) 4-6.7. Liu S, Blacam C, Lim F, Mattei P, Mamula P. Magnetic Foreign Body Ingestions Leading to Duodenocolonic

Fistula. JPediatr Gastroenterol Nutr, 2005; 41, 670- 672.8. Anselmi E, Roman C, Fontoba J, Gonza´lez L, Dieguez E, Gonza´lez J, et al. Intestinal perforation caused by

magnetic toys. J Pediatr Surg 2007; 42, E13–E16.9. Nui A, Hirama T, Katsuramaki T, Maeda T, Meguro M, Nagayama M, et al. An intestinal volvulus caused by

multiple magnet ingestion: an unexpected risk in children. J Pediatr Surg 2005; 40, E9–E11. 10.Kim J. Gastrojejunal Fistula with Jejunal Rotation Caused by Two Ingested Magnets in a Child: A Case Report. J

Korean Radiol Soc 2006; 55,153-156.

References

Associate Pediatric Surgery King Abdulla bin Abdul-Aziz

University Hospital _ PNU

Underestimation Of Magnetic Toys Ingestion In Children May Leads To Serious Gastrointestinal

Complications

Dr. Ali M Ahmad Consultant Pediatric Surgery;

MBBCh, MS, MD, MRCS-Ed, EBPS

Thank you