Magnetic foreign body ingestion: An avoidable attraction in children

Dear Editor,

Foreign body ingestion is a common occurrence all over the world, with 80% of the cases reported in children, with the most common age group being between six months and six years.¹ Although conservative management is enough in most cases, few require operative intervention in the form of endoscopy or surgery. In the last decade, there has been a rise in the sale of magnetic beads for use in toys and building sets for children which are readily available in shops and common online platforms. These high-powered magnets made of neodymium, iron, and boron are small pea size, often brightly colored, and are an easy target for curious children, leading to ingestion. As per the National Electronic Injury Surveillance System of USA, there has been a 75% increase in the incidence of magnetic foreign body ingestion since 2011;² however, Indian data are unavailable on this modern-day scourge.

The presentation is often delayed due to unwitnessed ingestion in children, and the symptoms are based on the timing and location of ingestion. Children may present with abdominal pain, vomiting, abdominal distension, and features of perforation.

We report a case of a 10-year-old girl child who presented to us with complaints of abdominal pain and multiple episodes of vomiting for a duration of 10 days. She gave a history of having ingested 10 magnetic beads 10 days ago and had not informed her parents due to fear of being scolded. The pain was localized to upper abdomen, aggravated by food, and the vomitus was nonbilious. Clinically, her vitals were stable, and an abdominal examination revealed a soft abdomen with epigastric tenderness. Abdominal radiography revealed a foreign body in the left upper quadrant with a normal gas pattern (Fig. 1). Urgent upper-GI endoscopy revealed extensive gastric mucosal erosions with the absence of foreign body in the stomach or duodenum. A trial of conservative management was attempted for five days; however, the location and number of foreign bodies remained static. Hence, surgical exploration was carried out through a limited upper midline laparotomy, and all the magnetic beads could be palpated in the upper jejunum with extensive adjoining serosal inflammation of the bowel and were removed with a small vertical enterotomy which was closed horizontally in two layers with absorbable monofilament sutures (Fig. 2). Postoperative recovery was uneventful, and the child was discharged on the 7th day. Parent/guardian consent was obtained for use of patient's images in a biomedical journal.

Fig. 1.

Radio graph of abdomen showing foreign body in the left upper quadrant.

Fig. 2.

Magnetic beads extracted from jejunum.

There is a lack of clear guideline in the management of magnetic foreign body ingestion.³ It is essential to ascertain the number of magnets, and being radio-opaque radiograph, they can help identify the number and location of the foreign body. Solitary magnets may pass spontaneously, whereas multiple magnetic foreign bodies tend to attract each other across the wall of intestines leading to obstruction, fistula formation, or even perforation.⁴ Therefore, multiple magnets need aggressive management in the form of early endoscopy and surgical exploration if warranted to avoid morbidity and mortality. In addition, community efforts and stringent laws need to be established, banning the sale of these small magnets, which may seem attractive to a child but sometimes may cost them their lives.

Patients/ Guardians/ Participants consent

Patients informed consent was obtained.

Ethical clearance

Not Applicable.

Source of support

Nil.

Disclosure of competing interest

The authors have none to declare.