ANNIE PUGEL, MD SEATTLE CHILDREN’S HOSPITAL UNIVERSITY OF WASHINGTON DEPARTMENT OF SURGERY Magnet Ingestion: A Standardized Approach.

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Presentation transcript:

ANNIE PUGEL, MD SEATTLE CHILDREN’S HOSPITAL UNIVERSITY OF WASHINGTON DEPARTMENT OF SURGERY Magnet Ingestion: A Standardized Approach

MA 7-year-old boy s/p swallowing magnets Transferred from Bellingham Presented to SCH 8-10 hours post ingestion Afebrile, benign abdomen Abdominal film shows magnet in left side of abdomen

MA

Magnet(s) on left side of abdomen Reassuring story Reassuring physical exam But….

CDC Data Magnet induced injuries from identified by CPSC  20 cases identified  19 requiring surgery  1 death CDC 2006

CDC data Voluntary recalls of certain toys  Magnetix  Polly Pocket

Magnet Ingestion What is the best management of patients who have swallowed multiple magnets?

Presentation Asymptomatic Mild abdominal pain Obstruction Bowel perforation Sepsis Fistula Death

Initial Evaluation Timing of ingestion  Synchronous vs. metachronous Number of magnets ingested Co-ingested objects  Other metal objects  Batteries Other considerations  Difficult historian  Young child

Initial Evaluation Imaging  Plain films  CT scan  Avoid MRI Endoscopy Physical exam  unreliable Shah, et al, 2009

Treatment Options Watch and wait Endoscopy Laparoscopy Laparotomy Dutta and Barzin, 2008.

Treatment Guidelines No formal consensus General guidelines  High index of suspicion  Serial radiographs  Early surgical consultation Standardized regimens

Treatment Algorithm Shah, et al, 2009

Other Treatment Options Catheter assisted removal Magnetic endoscopy Cathartics/laxatives

MA Known to have ingested multiple magnets Magnets moved with subsequent imaging  Postpyloric  Unclear positioning Exam reassuring

MA Limited CT to determine location of magnets

MA Magnets in cecum Admitted to Surgery Golytely, serial exams Serial abdominal films revealed forward movement of magnet Magnet still had not passed Discharge orders in

MA

Recommendations Diligent history and exam High index of suspicion Early surgical intervention Close observation Standardized approach to care

Sources Butterworth, J, and Feltis, B. Toy magnet ingestion in children: revising the algorithm. J Pediatr Surg. 2007; 42, E3-E5. Centers for Disease Control and Prevention (CDC). Gastrointestinal injuries from magnet ingestion in children: United States MMWR Morb Mortal Wkly Rep. 2006;55(48) Dutta, S, and Barzin, A. Multiple magnet ingestion as a source of severe gastrointestinal complications requiring surgical intervention. Arch Pediatr Adolesc Med. 2008; 162(2): Jamshidi, R, and Harrison, M. Response to: Multiple magnet ingestion as a source of severe gastrointestinal complications requiring surgical intervention. Arch Pediatr Adolesc Med. 2008;162(9):900 Shah, et al. Intestinal complications of magnet ingestion in children from the pediatric surgery perspective. Eur J Pediatr Surg. 2009; 19: Uchida, et al. Ingestion of multiple magnets: hazardous foreign bodies for children. Pediatr Radiol. 2006; 36: