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Emergency Management of the Ingested Magnet

An Algorithmic Approach

Bauman, Brent MD*; McEachron, Kendall MD*; Goldman, Deborah MD; Louiselle, Amanda BS; Zheng, Eugene BA; Mills, David MD§; Louie, Jeffrey MD§; Segura, Bradley MD, PhD*

doi: 10.1097/PEC.0000000000001168
Illustrative Cases
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Introduction Accidental ingestion of foreign bodies is an increasing problem in the pediatric population. Symptoms are often nonspecific and may lead to a missed diagnosis because the ingestion event often goes unwitnessed.

Case We present a case of a missed diagnosis of a multiple magnet ingestion event in a pediatric patient leading to operative management. A 2-year-old boy with a 4-week history of nonspecific abdominal pain presented to the emergency department (ED) with vomiting and worsening abdominal pain. He was recently seen in the ED for nonspecific abdominal pain diagnosed as acute otitis media. In this second ED visit, the child was found to be febrile and tachycardic and had signs of peritonitis. Radiographs revealed a foreign body in the right lower quadrant. The child was taken to the operating room where multiple intestinal perforations were identified and repaired. The child had an uneventful postoperative course and was discharged 7 days later.

Discussion There are increasing awareness and growing concern over complications from pediatric magnet ingestion. Complications from neodymium magnet ingestion may include bowel obstruction, perforation, and fistula formation. The risk of complications is especially high with multiple-magnet ingestion. Pediatric foreign-body magnet ingestion may be a diagnostic challenge because the associated symptoms are nonspecific, and the ingestion is often unwitnessed.

Conclusions Our case represents the missed diagnosis of 4 magnets ingested separately over time. Emergency department providers may benefit from a clinical algorithm guiding the management of these increasingly prevalent patient presentations to prevent delayed diagnoses and to decrease morbidity.

From the *Department of Surgery, University of Minnesota, Masonic Children’s Hospital, Minneapolis, MN

Department of Pediatrics, Cleveland Clinic, Cleveland, OH

University of Minnesota School of Medicine

§Department of Emergency Medicine, University of Minnesota, Minneapolis, MN.

Disclosure: The authors declare no conflict of interest.

Reprints: Bradley Segura, MD, PhD, 2450 Riverside Ave S, East Bldg MB505, Minneapolis, MN 55454 (e-mail: bjsegura@umn.edu).

Online date: May 1, 2017

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