Emergency Management of Pediatric Magnet Ingestion
A child who has swallowed a small magnet requires immediate emergency endoscopy (preferably within 2 hours, at latest within 6 hours) due to the risk of pressure necrosis if the magnet becomes trapped in the digestive tract. 1
Initial Assessment
Obtain immediate plain radiographs (X-rays) of the neck, chest, and abdomen to:
- Confirm presence of the magnet
- Determine exact location
- Identify whether there is more than one magnet or other metallic objects
- Look for signs of complications (perforation, obstruction)
CT scan should be performed if there are any signs of perforation or other complications that may require surgical intervention 1
Management Algorithm Based on Radiographic Findings
Single Magnet
If in esophagus:
- Emergent endoscopic removal (within 2-6 hours)
- Do not delay for contrast studies 1
If in stomach or beyond but patient is symptomatic:
- Emergent endoscopic removal
- Consider surgical consultation if endoscopic removal is not feasible
If in stomach or beyond and patient is asymptomatic:
- Close observation with serial X-rays to confirm passage
- Endoscopic removal if progression stops
Multiple Magnets or Magnet with Other Metallic Object
- Immediate endoscopic removal regardless of location due to high risk of intestinal necrosis from pressure between magnets trapping bowel wall 1
- Surgical consultation should be obtained early
Warning Signs Requiring Immediate Intervention
- Abdominal pain
- Vomiting
- Fever
- Signs of gastrointestinal bleeding
- Signs of peritonitis
- Failure to pass the magnet within expected timeframe
Important Cautions
- Never delay intervention for contrast studies - these are not recommended and may delay critical treatment 1
- Do not wait for symptoms to develop with magnet ingestions, as intestinal damage can occur silently
- Multiple magnets are particularly dangerous even if they appear to be in the same location on X-ray, as they may be in different loops of bowel attracting each other
- Rare-earth magnets (neodymium) are especially hazardous due to their strong magnetic forces
Follow-up
- Confirm complete removal of all magnetic foreign bodies
- If managed conservatively, document passage of magnet in stool
- Follow-up imaging to ensure complete passage if managed non-operatively
The management of magnet ingestion differs significantly from other foreign body ingestions due to the unique risks of magnets attracting across bowel walls, potentially leading to pressure necrosis, perforation, fistula formation, peritonitis, and even death if not managed promptly.