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Multiple Magnet Ingestion Alert

Department of Radiology, Cincinnati Children’s Hospital, 3333 Burnet Avenue, #5031, Cincinnati, OH 45229. e-mail: oestreich.ae@cchmc.org

Editor:

Because of the urgency of this message, I present it in the form of a letter to the editor. While awaiting publication of an abstract and my commentary in the soon-to-appear 2004 Year Book of Diagnostic Radiology (1) about the danger of ingestion of more than one magnet, I encountered a clinical example that emphasized the importance of radiographic observations.

The message in brief is that any time more than one magnet passes beyond the pylorus of a child (or, for that matter, an adult), an emergency danger of necrosis and perforation exists, and urgent surgical consideration is required. When two magnets lie in adjacent bowel loops, they may attract each other across the walls, leading to necrosis and eventually perforation and peritonitis.

An autistic boy aged 12 years 7 months presented to my institution after several days of apparent abdominal discomfort. That he had swallowed many magnets at summer camp was not known to the parent or the physicians. The abdominal radiograph obtained at presentation showed multiple objects with metallic density throughout the region of the small and perhaps also the large bowel; no free gas was evident. Until proved otherwise, this represented multiple small magnets and thus was a surgical emergency. The following day, a large number of small magnetic elements from a toy were surgically removed and were associated with areas of small bowel necrosis and indeed local perforation. An illustration of 12 similar small magnets in a 9-year-old girl with perforation may be found in the recent pediatric literature (2).

All radiologists should be on the alert. Moreover, if the possibility of magnets in the abdomen exists, magnetic resonance imaging is to be stringently avoided, lest damage be done.

REFERENCES

1. Oestreich AE. Pediatric radiology. In: Osborn AG, eds. 2004 year book of diagnostic radiology. Philadelphia, Pa: Mosby, In press.
2. Cauchi JA, Shawis RN. Multiple magnetic ingestion and gastrointestinal morbidity. Arch Dis Child 2002; 87:539-540.[Abstract/Free Full Text]

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