Multiple Perforations Due to Unwitnessed Ingestion of Multiple Magnets

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TL;DR

This case report describes a 10-month-old girl who presented with vomiting and fussiness after unwitnessed ingestion of multiple high-powered magnets, leading to multiple perforations in the stomach, duodenum, and jejunum requiring surgical repair and bowel resection. The case highlights the severe complications of multiple magnet ingestion, including bowel perforation and fistula formation, and emphasizes the need for high clinical suspicion and prompt surgical intervention. Since the 2016 US court ruling that relaxed safety standards for high-powered magnets, the incidence of magnet ingestion has increased, underscoring the importance of prevention and early recognition.

Full summary

2,384 CHARS

**Background:** Foreign body ingestion is common in children under 5 years old, and most objects pass spontaneously. However, ingestion of multiple high-powered magnets poses a unique risk because they can attract each other across bowel walls, leading to pressure necrosis, perforation, fistula formation, or obstruction. Since the 2016 US Court of Appeals for the Tenth Circuit overturned the safety standard for high-powered magnets, poison control calls regarding magnet ingestion have dramatically increased, making this an important clinical issue.

**Methods:** This is a case report of a 10-month-old girl who presented to the emergency department with a 2-day history of vomiting and fussiness. No foreign body ingestion was witnessed, but the family reported having high-powered magnets of unknown brand at home. An abdominal X-ray revealed a radiopaque foreign body resembling a beaded bracelet in the stomach. Esophagogastroduodenoscopy (EGD) was performed, which visualized 3 magnets at the lesser curvature of the stomach eroding into the mucosa and 2 magnets in the duodenum. Fluoroscopy identified a total of 15 magnets, each 5 mm in size, arranged in a circle. An exploratory laparotomy was then performed.

**Key Results:** During laparotomy, multiple perforations were found in the stomach, duodenum, and jejunum. The surgeons repaired the perforations and performed a 10 cm jejunal resection. The patient recovered after surgery. The paper does not provide specific follow-up details or long-term outcomes.

**Clinical Implications:** This case underscores the severe complications that can arise from multiple magnet ingestion, even when the ingestion is unwitnessed. The presence of a radiopaque foreign body resembling a beaded bracelet on X-ray should raise suspicion for magnet ingestion, especially in children with access to high-powered magnets. Prompt endoscopic or surgical intervention is warranted when two or more magnets are present, as the bowel wall between them is at risk for perforation, fistula formation, or obstruction. The increase in magnet ingestion cases since the 2016 court ruling highlights the need for renewed safety regulations and public awareness. Clinicians should maintain a high index of suspicion for magnet ingestion in any child presenting with unexplained gastrointestinal symptoms and a radiopaque foreign body on imaging.