What are the treatment steps for a child or individual with a history of psychiatric illness or dementia who has ingested a 0.8 cm magnet?

Management of 0.8 cm Magnet Ingestion

Proceed immediately to emergent endoscopic removal within 2-6 hours regardless of symptoms or radiographic findings, as magnet ingestion carries high risk of pressure necrosis, perforation, and fistula formation that can rapidly compromise morbidity and mortality. 1

Immediate Diagnostic Steps

Obtain CT Scan Immediately

• Do not rely on plain radiographs alone - they have a false-negative rate up to 47% for foreign body detection and only 32% sensitivity compared to 90-100% for CT scan 1
• CT imaging is the key examination to definitively identify the magnet(s), determine exact location, assess number of magnets present, and detect early complications including perforation, obstruction, or fistula formation 2, 1
• The absence of radiographic findings on plain films does NOT exclude magnet ingestion when history is suggestive 1

Activate Emergency Endoscopy Protocol

• Emergent flexible endoscopy must occur within 2-6 hours of presentation, as magnets create pressure necrosis between multiple magnets or between a magnet and other metallic objects 1
• This urgent timeframe applies regardless of whether single or multiple magnets are suspected, as even a single magnet is dangerous if there is any possibility of co-ingestion with other metallic objects 1
• Do not delay endoscopic removal - tissue damage occurs rapidly and can lead to life-threatening complications 2

Pre-Endoscopy Management

Nothing by Mouth

• Do not administer anything by mouth including water or milk 2
• Do not induce vomiting or administer activated charcoal 2
• These interventions do not apply to magnet ingestion the way they might for button batteries (where honey/sucralfate have limited utility) 2

Special Considerations for Psychiatric Illness/Dementia Patients

• Patients with psychiatric illness or dementia may have impaired ability to provide accurate history or cooperate with examination 3, 4
• Ensure adequate supervision and monitoring as these patients may have behavioral symptoms that complicate acute medical management 4
• Consider need for sedation during endoscopy, but prioritize airway safety and ability to perform the procedure emergently 5

Critical Pitfalls to Avoid

• Never rely on negative x-ray to exclude magnet ingestion when history is positive - proceed directly to CT imaging 1
• Do not use contrast swallow studies - they increase aspiration risk and impair endoscopic visualization 1
• Do not adopt a "wait and see" approach - unlike some foreign bodies that can pass spontaneously, magnets require urgent intervention regardless of location in the GI tract 1
• Do not underestimate risk in patients with cognitive impairment who may have ingested multiple objects or magnets without reliable history 3, 4

Post-Removal Considerations

• Obtain surgical consultation early if CT or endoscopy reveals signs of perforation, extensive necrosis, or if endoscopic removal is unsuccessful 6
• Monitor for delayed complications including stricture formation, fistula development, or perforation even after successful removal 6
• For patients with psychiatric illness or dementia, psychiatric evaluation and environmental safety assessment should occur to prevent repeat ingestion 6, 3