A. M. Waters1, D. H. Teitelbaum2, D. T. Bartle1, V. Thorne1, A. Bousvaros3, R. A. Noel4, E. A. Beierle1 1University Of Alabama,Birmingham, Alabama, USA 2University Of Michigan,Ann Arbor, MI, USA 3Children’s Hospital Boston,Boston, MA, USA 4Baylor College Of Medicine,Houston, TX, USA
Introduction: In children, most ingested foreign bodies will pass spontaneously without incident however; several reports describe significant sequelae associated with rare earth magnet ingestions. The maker of the most popular of these toys, Buckyballs® , has stopped production, but these magnets continue to be found in items marketed to adults. The aim of this survey was to determine the surgical interventions and outcomes of magnet ingestions in the pediatric population.
Methods: Following IRB approval, an online survey tool was developed and distributed via email to all pediatric surgeons with membership in the Surgical Section of the American Academy of Pediatrics. Respondents were anonymous and data tallied by a blinded investigator.
Results: Out of about 630 surgeons polled, 101 responded reporting data on 99 magnet ingestions. The majority of ingestions reported (71%) occurred after year 2010. Two thirds (66%) of the ingestions were in boys, the median age at ingestion was 3.7 years (range: 1-16 years), and most of the children were Caucasian (80%). In 34% of the children, over 48 hours lapsed between the reported time of ingestion and initiation of interventions. All but one child had an x-ray study for magnet localization and abdominal films were the most commonly ordered test. Thirty-two patients (32%) underwent endoscopy with successful removal of magnets in 70%; primarily from the esophagus, stomach and duodenum. At endoscopy, multiple magnets were commonly found (65%) (range: 2 to 27 magnets) and removed. One quarter of these children required subsequent surgery for complications noted on endoscopy. In total, 73 children required either laparotomy (51) or laparoscopy (22) for magnet removal, and removal was successful in over 96% of attempts. At surgery, 90% of children were discovered to have ingested more than one magnet with the number of magnets retrieved ranging from 1-45. In addition, 17% of the children were found to have at least one perforation or fistula and 34% of children had multiple perforations or fistulae. Most did well following their surgical interventions, but some (n=8) required prolonged (>7 days) hospitalization or additional surgical procedures (n=4) including reoperations for missed perforation and leak from a colotomy resulting in a colostomy. Reported long-term outcomes (>30 days) included 9 children requiring long-term care for their injuries including repeat endoscopies. One child died following hemorrhage from an esophago-aortic fistula.
Conclusion: The findings of this survey demonstrate that rare earth magnets remain a serious health hazard for children, especially in the younger age ranges. Ingestions of these objects may result in serious injuries to the gastrointestinal tract, even when removed expeditiously. Surgeons must look for multiple magnets when encountered with such cases, and every effort should be made to remove these objects either by endoscopic or surgical means when discovered.