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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3182990a82
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Volvulus and Intestinal Perforation Following Magnet Toy Ingestion

Montaruli, Ernesto

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Department of Paediatric Surgery, Centre Hospitalier Universitaire de Bicêtre–Université Paris Sud, 78, Rue du General Leclerc, Le Kremlin Bicêtre, France.

Address correspondence and reprint requests to Ernesto Montaruli, MD, Department of Pediatric Surgery, Centre Hospitalier Universitaire de Bicêtre–Université Paris Sud, 78, Rue du General Leclerc, 94270 Le Kremlin Bicêtre, France (e-mail: ernesto.montaruli@gmail.com).

Received 15 April, 2013

Accepted 25 April, 2013

The author reports no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 7-year-old boy transferred to our surgical service had been admitted 4 days earlier to a community hospital for abdominal pain after ingestion of multiple magnetic toys; initial abdominal radiograph revealed multiple magnetic toys (Fig. 1A) with no evidence of intestinal obstruction. After 4 days of inpatient observation, he developed abdominal distension, with increasing abdominal pain and emesis. Radiograph revealed dilated intestine with rotation of the object (Fig. 1B). He was transferred to our pediatric surgical service for emergency laparotomy. Small bowel volvulus associated with multiple intestinal and mesenteric perforations was found (Fig. 2A). Eleven magnetic toys and a 5-cent coin were removed (Fig. 2B), the volvulus was reduced, and the perforations were repaired. Postoperative course was unremarkable.

Figure 1
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Figure 2
Figure 2
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Ingestion of magnetic toys is rare in children. Magnetic attraction force causes pressure bowel necrosis with perforation, fistula, or volvulus (1). The number, location, and the timing of magnet ingestion guide the roles of the pediatric gastroenterologists and surgeons in the management (2). Radiography is an indispensable component in these decisions (3). Close observation and early intervention, through endoscopy or surgical exploration, may help prevent more severe complications. Public education and prevention efforts are indispensable to decrease the incidence of ingestion of magnet toys (4).

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REFERENCES

1. Adu-Frimpong J, Sorrell J. Magnetic toys: the emerging problem in pediatric ingestions. Pediatr Emerg Care 2009; 25:42–43.

2. Hussain SZ, Bousvaros A, Gilger M, et al. Management of ingested magnets in children. J Pediatr Gastroenterol Nutr 2012; 55:239–242.

3. Otjen JP, Rohrmann CA, Iyer RS. Imaging pediatric magnet ingestion with surgical-pathological correlation. Pediatr Radiol 2012; [Epub ahead of print].

4. Abbas MI, Oliva-Hemker M, Choi J, et al. Magnet ingestions in children presenting to US emergency departments, 2002–2011. J Pediatr Gastroenterol Nutr 2013; 57:18–22.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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