What is the treatment for a child who ingested a magnet?

Management of Magnet Ingestion in Children

Immediate endoscopic removal is mandatory for all cases of magnet ingestion in children, with timing dependent on the number of magnets and their location. 1, 2

Initial Assessment and Imaging

• Obtain immediate radiographic imaging (X-ray) to confirm the presence, number, and location of magnets 3, 4
• CT scan is recommended if perforation or other complications are suspected 1
• Assess for signs of peritonitis or intestinal obstruction (abdominal pain, vomiting, fever) 4, 5

Management Algorithm Based on Number of Magnets

Single Magnet Ingestion

• If located in the esophagus: Emergent endoscopic removal (within 2-6 hours) regardless of symptoms 1, 2
• If located in the stomach or beyond and patient is asymptomatic: Urgent endoscopic removal (within 24 hours) 2, 4
• Follow-up imaging to confirm passage if endoscopic removal is not performed 4

Multiple Magnet Ingestion

• Multiple magnet ingestion is a medical emergency requiring aggressive management due to high risk (50%) of intestinal perforation 4, 5
• Immediate endoscopic removal if magnets are accessible in the upper GI tract 3, 5
• Surgical intervention (laparoscopy or laparotomy) is indicated if:
  • Signs of peritonitis are present 4, 6
  • Magnets are not accessible by endoscopy 5
  • Magnets have not progressed through the GI tract on serial imaging 3, 7

Specific Interventions

• Do not administer anything by mouth except honey (in children >1 year) or sucralfate if ingestion is <12 hours old and removal will be delayed 1
• Do not induce vomiting or administer activated charcoal 1
• Do not delay intervention - tissue damage can occur rapidly due to pressure necrosis between magnets across intestinal walls 1, 5
• For surgical cases, careful inspection of the entire GI tract is necessary to identify all points of injury 6

Post-Removal Monitoring

• Monitor for signs of perforation, fistula formation, or peritonitis even after successful removal 4, 6
• Follow-up imaging may be necessary to ensure complete removal of all magnetic foreign bodies 5
• Extended monitoring is required for patients with confirmed intestinal injury 6

Complications to Watch For

• Intestinal perforation (occurs in 17% of surgical cases) 6
• Multiple perforations or fistulae (occurs in 34% of surgical cases) 6
• Ischemic necrosis of intestinal tissue 7
• Potential for severe hemorrhage in rare cases 6

Prevention

• Public education about the dangers of magnet ingestion is crucial 3
• Proper storage of magnetic toys away from young children 3
• Support for regulatory measures to limit availability of high-powered magnets 3, 6