Magnetic Mishap: Multidisciplinary Care for Magnet Ingestion in a 2-Year-Old

Abstract

Background/Objectives: A 2-year-old male presented to the emergency department (ED) with vomiting and abdominal discomfort following ingestion of multiple magnets from a sibling’s bracelet. This case highlights the risks associated with magnet ingestion and the need for coordinated multidisciplinary care and public health intervention. Methods: Radiographs revealed magnets in the oropharynx, stomach, and small bowel. Emergency physicians coordinated care with otolaryngology, gastroenterology, and general surgery. Results: Laryngoscopy successfully removed two magnets from the uvula, and endoscopy retrieved 30 magnets from the stomach. General surgery performed a diagnostic laparoscopy, identifying residual magnets in the colon. Gastroenterology attempted a colonoscopy but was unable to retrieve magnets due to formed stool, leading to bowel preparation and serial imaging. The patient eventually passed 12 magnets per rectum without surgical intervention. Conclusions: This case emphasizes the importance of multidisciplinary collaboration in managing magnet ingestion, a preventable cause of serious gastrointestinal injury. Recent studies highlight the increasing incidence and severity of such cases due to accessibility and inadequate regulation. These findings underscore the need for public awareness and adherence to management protocols to mitigate morbidity and mortality in pediatric patients.

1. Introduction

Foreign body ingestion is commonly seen in pediatric patients under five years of age [1]. Since the early 2000s, the rising popularity and availability of neodymium magnets—rare earth magnets—have led to an increase in cases of magnet ingestion among children [1]. If multiple high-power magnets are ingested, they can pose a significant morbidity due to their strong attractive forces [2]. Many of these children require hospitalization, and approximately 10% have life threatening complications [1]. These complications can include choking, bowel obstruction, tissue necrosis, perforation, fistula formation, or rarely even death [2].

According to the latest NASPHGAN, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, the algorithm for magnet ingestion is relatively straightforward [3]. If a magnet ingestion is symptomatic or multiple magnets are ingested, removal is recommended. If the magnet ingestion is asymptomatic, and multiple pieces are noted on x-ray, patients are typically admitted for observation with serial x-rays to confirm unobstructed passage. The following case illustrates how these guidelines inform clinical decision-making in the setting of a 2-year-old male with delayed recognition of multiple magnet ingestion from his sibling’s bracelet, requiring prompt intervention and multidisciplinary management.

2. Initial Evaluation

A 2-year-old male presented to the emergency department (ED) with persistent vomiting and abdominal discomfort following ingestion of multiple magnets from a sibling’s bracelet. His parents noted delayed recognition of the ingestion until symptoms escalated, with the admission taking place twenty-four hours post-ingestion. On examination, the patient was afebrile, with mild abdominal tenderness but no signs of peritonitis or hemodynamic instability.

Plain radiographs demonstrated metallic densities clustered in the oropharynx, stomach, and small bowel (Figure 1). Recognizing the risks of gastrointestinal perforation and necrosis, the ED team initiated immediate multidisciplinary consultations with otolaryngology, gastroenterology, and general surgery. Magnet ingestions have been increasingly reported in pediatric literature due to their accessibility and the unique risks they pose to gastrointestinal tissues [4,5,6,7,8,9,10].

3. Intervention in the Hospital

Interventions occurred across multiple anesthetic settings. Otolaryngology performed direct laryngoscopy, successfully removing two magnets adhered to the uvula with minimal trauma, consistent with findings from previous studies [4]. Gastroenterology then conducted an upper endoscopy, revealing a tightly clustered arch of 30 bb-sized magnets compressing the gastric incisura (Figure 2). Using a Roth net, they removed the magnets in two passes with no complications other than minor erosions on the gastric mucosa. Post-procedural imaging revealed residual magnets in the proximal jejunum (Figure 3).

Due to concerning gas patterns 36 h into admission and inability to locate all magnets on imaging, general surgery proceeded with diagnostic laparoscopy. The laparoscopy revealed a single magnet in the hepatic flexure of the colon and a cluster of magnets in the splenic flexure.

Colonoscopy was attempted by pediatric gastroenterology in an unprepped colon to avoid procedural delays. Due to formed stool, retrieval was unsuccessful. A nasogastric tube was placed for MiraLAX-based bowel prep, and serial abdominal x-rays were performed (Figure 4a,b). This approach aligns with conservative management strategies reported in the literature [3,11].

Outcome

On the day of discharge, the patient had passed 12 magnets per rectum, with significant clinical improvement. He tolerated oral intake without recurrence of symptoms, and follow-up imaging confirmed complete resolution of the foreign bodies. The patient was discharged home with instructions for continued monitoring and dietary adjustments to ensure recovery (Figure 5).

4. Discussion

High-powered magnet ingestion in children poses unique challenges due to the magnetic forces that can cause tissue compression, necrosis, and perforation. Recent cases have demonstrated the potential for severe complications, including gastrointestinal fistulas, volvulus, and perforations, necessitating surgical intervention [7,8,9].

This case highlights the importance of a multidisciplinary approach, with emergency physicians playing a central role in initiating timely interventions and coordinating care across specialties. The collaboration and cooperation amongst otolaryngology, general surgery, and gastroenterology specialists was essential to the successful outcome in our case. This highlights the need for adoption of protocols, such as those published by NASPGHAN, that facilitate quick and effective interdisciplinary coordination in similar cases [3,11].

Regulatory actions targeting the design and sale of high-powered magnets have fluctuated over the years, correlating with the incidence of ingestion cases [1,12]. The U.S. Consumer Protection Safety Commission has approved a new federal standard to reduce significant risk factors such as the strength of smaller magnets sold on the market, going into effect in 2022 [12]. Since stricter regulation has correlated with lower incidence, this recent reintroduction of stringent regulation may have a lasting impact on the incidence of ingestion in the U.S [1]. Efforts to advocate for safer design practices must be aimed at manufacturers. However, magnets remain accessible, necessitating continued public health efforts to educate parents and caregivers about associated risks.

5. Conclusions

This case underscores the essential role of the ED in managing complex foreign body ingestions through rapid diagnosis, multidisciplinary collaboration, and conservative management strategies. It highlights the need for regulatory advocacy and public awareness to prevent pediatric magnet ingestion and associated complications.

Why Should an Emergency Physician Be Aware of This?

This case demonstrates how ED providers can play a central role in coordinating care and employing non-invasive techniques for managing complex foreign body ingestion. Recognizing the risks associated with magnet ingestion and understanding the value of rapid imaging and multidisciplinary approaches can significantly improve patient outcomes.