Innovative Makeshift Technique for Removing Ingested Rare Earth Magnets

**Background:** Ingestion of foreign bodies is common in pediatrics, but rare earth magnets (neodymium alloy) pose unique dangers due to their powerful attractive forces. When positioned in separate areas of the intestinal tract, these magnets can attract each other across bowel walls, leading to obstruction, perforation, fistula formation, or pressure necrosis. NASPGHAN guidelines recommend urgent endoscopic removal of ingested magnets before they enter the small intestine to prevent severe adverse events. However, endoscopic localization and removal can be challenging, particularly when the child has not been in a fasting state and the stomach contains food debris that obscures visualization.

**Methods:** This is a single case report describing a makeshift endoscopic retrieval technique. A 13-year-old patient presented after accidentally swallowing several rare earth magnets. Initial plain abdominal radiograph revealed 8 magnets arranged in a circular configuration projecting in the upper abdominal area. Urgent upper gastrointestinal endoscopy was performed under general anesthesia with endotracheal intubation. Upon entering the stomach, a large food bolus was present and no magnets were visible despite extensive flushing and suctioning. The endoscope was removed, and a single magnet from the same toy was secured in a Roth net, then reintroduced endoscopically.

**Key Results:** The single prototype magnet did not hinder endoscopic vision. The magnetic attractive force was strong enough to pull the ingested ring of 8 magnets out of the undigested food bolus. The resulting ring of all 9 magnets (the 8 ingested magnets plus the prototype retrieval magnet) was successfully recovered in one attempt. The number of retrieved magnets exactly matched the count on the initial x-ray. The patient tolerated the procedure without complications and was discharged home.

**Clinical Implications:** This case demonstrates a novel, low-cost technique for retrieving ingested magnets when standard endoscopic visualization is impaired by food debris. The approach leverages the same magnetic properties that make these foreign bodies dangerous—using a prototype magnet to attract and extract the buried magnets en masse. The authors acknowledge certain risks, including the possibility of attracting a more distally located magnet or losing the magnets during endoscopic removal. Despite these limitations, this technique offers a practical solution for urgent magnet removal in non-fasted pediatric patients, potentially avoiding the need for more invasive surgical intervention. The case reinforces the importance of prompt endoscopic removal of multiple ingested magnets even in asymptomatic patients, as recommended by NASPGHAN guidelines.