Developing a management protocol for magnet ingestion in pediatric patients.

Abstract

The availability of ingestible products containing magnetic components has resulted in a continued increase in magnet ingestion in children. The ingestion of multiple magnets may cause complications requiring surgical intervention. We aimed to develop a management protocol for children who have ingested multiple magnets. A retrospective review was performed including children seen at a freestanding children's hospital who ingested a foreign body concerning for magnet(s) from 2000 to 2024. We collected information on symptoms, radiologic studies, and interventions performed. We identified 143 children who ingested 1 or more magnets over the 24-year period. Seventy-four percent (n = 106) of ingestions were unwitnessed, and 57% (n = 81) of ingestions involved multiple magnets. Of the children who ingested multiple magnets, 53% (n = 43) were managed with observation and serial radiographs. In most of these children, 58% (n = 25) were asymptomatic and passed the magnets without intervention. A lack of radiographic progression of the magnet(s) was deemed a failure of conservative management, which occurred in 41% (n = 18) of cases, and 94% (n = 17) of those children required surgical intervention. Enteroenteric fistula, bowel perforation, and/or bowel obstruction were the most common operative findings. Among the single magnet ingestion group, 94% (n = 58) were managed conservatively, with 6.5% (n = 4) requiring an intervention because of worsening symptoms. We developed an algorithm that encourages prompt operative intervention for children with no magnet progression. Lack of foreign body progression on imaging by 24 hours in children conservatively managed for multiple magnet ingestion should prompt surgical intervention.