From the Guidelines

Magnet ingestion in pediatric patients requires immediate attention and intervention.

The approach to investigating a suspected magnet ingestion in a pediatric patient involves:

Emergent flexible endoscopy (preferably within 2 hours, at latest within 6 hours) is recommended due to the risk of pressure necrosis 1.
Initial evaluation should be based on the patient’s history and physical examination, with recommended biochemical investigations including complete blood count (CBC), C-reactive protein (CRP), blood gas analysis for base excess, and lactate 1.
Imaging investigations should include neck, chest, and abdominal radiographs to assess the presence, location, shape, and size of radiopaque or unknown shape objects 1.
Computed Tomography (CT) scan should be performed in patients with suspected perforation or other complications that may require interventional endoscopy or surgery 1.

Endoscopy is the main diagnostic tool for esophageal/gastric strictures in symptomatic patients and remains the upfront evaluation examination in children 1.
Emergency endoscopy should be performed if CT is unavailable, CT with contrast administration is contraindicated, or in the pediatric population 1.

Contrast swallow is not recommended and should not delay other investigations/interventions 1.
Oral contrast studies should be avoided in patients with complete esophageal obstruction and inability to swallow saliva due to the increased risk of aspiration 1.

From the Research

The approach to investigating a suspected magnet ingestion in a pediatric patient involves a combination of clinical evaluation, imaging studies, and endoscopic or surgical intervention, as seen in cases reported by 2, 3, 4, 5, 6.
Clinical manifestations of magnet ingestion may include abdominal pain, vomiting, and fever, as noted in studies 3, 4, 6.
Imaging studies, such as abdominal x-rays, may be used to identify the location and number of magnets ingested, as described in 2, 4, 6.

Management options for magnet ingestion include endoscopic extraction, surgical removal, and observation with serial radiographs, as discussed in 2, 3, 4, 5, 6.
Endoscopic extraction may be attempted if the magnets are accessible and the patient is asymptomatic, as reported in 2.
Surgical removal is warranted in patients with symptoms suspicious of intestinal obstruction and/or perforation, or without magnet migration, as noted in 3, 4, 6.
Asymptomatic children can be observed over at least 2-3 days with serial simple radiographs while awaiting magnet migration, as suggested in 4.

Early diagnosis and management of magnet ingestion are crucial to reduce the risk of complications, such as intestinal perforations, bowel strangulation, and necrosis, as emphasized in 3, 5, 6.
A clinical algorithm guiding the management of pediatric magnet ingestion can help prevent delayed diagnoses and decrease morbidity, as proposed in 5, 6.