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ANNIE PUGEL, MD SEATTLE CHILDREN’S HOSPITAL UNIVERSITY OF WASHINGTON DEPARTMENT OF SURGERY Magnet Ingestion: A Standardized Approach
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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
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MA
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Magnet(s) on left side of abdomen Reassuring story Reassuring physical exam But….
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CDC Data Magnet induced injuries from 2003-2006 identified by CPSC 20 cases identified 19 requiring surgery 1 death CDC 2006
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CDC data Voluntary recalls of certain toys Magnetix Polly Pocket
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Magnet Ingestion What is the best management of patients who have swallowed multiple magnets?
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Presentation Asymptomatic Mild abdominal pain Obstruction Bowel perforation Sepsis Fistula Death
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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
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Initial Evaluation Imaging Plain films CT scan Avoid MRI Endoscopy Physical exam unreliable Shah, et al, 2009
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Treatment Options Watch and wait Endoscopy Laparoscopy Laparotomy Dutta and Barzin, 2008.
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Treatment Guidelines No formal consensus General guidelines High index of suspicion Serial radiographs Early surgical consultation Standardized regimens
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Treatment Algorithm Shah, et al, 2009
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Other Treatment Options Catheter assisted removal Magnetic endoscopy Cathartics/laxatives
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MA Known to have ingested multiple magnets Magnets moved with subsequent imaging Postpyloric Unclear positioning Exam reassuring
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MA Limited CT to determine location of magnets
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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
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MA
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Recommendations Diligent history and exam High index of suspicion Early surgical intervention Close observation Standardized approach to care
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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 2003-2006. MMWR Morb Mortal Wkly Rep. 2006;55(48) 1296-1300. 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):123-125. 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; 19:328-340. Uchida, et al. Ingestion of multiple magnets: hazardous foreign bodies for children. Pediatr Radiol. 2006; 36:263-264.
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