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Abstract
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The study by Faruque and Khan, highlighting the dangers of foreign body ingestions causing unintentional injuries in children is interesting. We would like to congratulate the authors for providing an authoritative overview on the topic and would like to further highlight an evolving challenge resulting from two dangerous foreign body ingestions, which are increasingly being seen in clinical practice with their unique set of problems. While coins traditionally have been the most common object ingested by young children, toy magnets and button batteries are now much more commonly reported than even a decade ago.
Although ingestion of magnets have been reported in the past, availability of powerful neodymium magnets currently being sold as adult desktop tops is enabling availability of extremely dangerous objects within easy reach of young children. There has been a dramatic 8.5-fold increase in the incidence of accidental ingestion of magnets among children in the US between 2002 - 2011; with about three quarters of these cases reported after 2008. A Canadian study reported an increased incidence by a factor of 2.94 between 2002 - 2009 and 2010 - 2012; the median age was 4.5 years and 65% were male.
Following ingestion of a single magnet, complications are unlikely as in most cases it will traverse the gastrointestinal tract and get defecated. However, multiple magnets when ingested can traverse at different rates and, therefore, lie in several adjacent bowel loops. Magnets located up to 6 bowel loops apart have been known to attract each other. This leads to pressure ischemia and necrosis, volvulus, entero-enteric fistula formations and even perforation, which carry significant morbidity and mortality risks. A child may, therefore, present with acute bowel obstruction, abdominal pain, bilious vomiting; but may have had entirely normal examination findings in the initial stages. Abdominal X-ray can reveal radio-opaque objects, likely to be the ingested magnets.
Data from the American Academy of Pediatrics National Conference and Exhibition Survey showed that 52% of patients who had ingested magnets needed endoscopic intervention alone, 20% required endoscopy and surgery, while 8% required surgical removal of the magnets. Only 15% of ingestions were managed by observation alone...
Keywords: Multiple magnet ingestion
Language: en |