IngestionofMagneticToys:ReportofSeriousComplications RequiringSurgicalInterventionandaProposedManagementAlgorithm

Context:�Increasingpopularityofstrongmagnetsastoyshasledtotheiringestion� bychildren,�puttingthematriskofpotentiallyharmfulgastrointestinaltractinjuries. Objectives:�Toheightenphysicianawarenessofthepotentialcomplicationsofmag- neticforeignbodyingestion,�andtoprovideanupdatedalgorithmformanagementof� apatientwhoissuspectedtohaveingestedmagnets. Design:�Aretrospectivereviewofmagnetingestionstreatedoveratwo-yearperiod� atourinstitutionsintheSouthernCaliforniaPermanenteMedicalGroup.�Datainclud- ingpatientdemographics,�clinicalinformation,�radiologicimages,�andsurgicalrecords� wereusedtoproposeamanagementstrategy.� Results:� Fivepatients,� aged� 15� monthsto� 18� years,� presentedwithabdominal� symptomsaftermagnetingestion.�Fourofthe�5�patientssufferedseriouscomplications,� includingbowelnecrosis,�perforation,�fistulaformation,�andobstruction.�Allpatients� weresuccessfullytreatedwithlaparoscopic-assistedexplorationwithorwithoutendos- copy.�Totaldaysinthehospitalaveraged�5.2�days�(range�=�3�to�9�days).�Averagetimeto� dischargefollowingsurgerywas�4�days�(range�=�2�to�7�days).�Exvivoexperimentation� withtoymagneticbeadswereperformedtorevealcharacteristicsofthemagnetictoys.� Conclusions:�Physiciansshouldhaveaheightenedsenseofcautionwhentreatinga� patientinwhommagneticforeignbodyingestionissuspected,�becauseofthepotential� gastrointestinalcomplications.�Anupdatedmanagementstrategyisproposedthatboth� preventsdelaysinsurgicalcareandavoidsunnecessarysurgicalexploration.