Swallowed magnets and batteries: a dangerous but not unexpected attraction.

An 18-month-old boy was witnessed swallowing a cluster of five magnetic toy balls. He was coincidentally noted on plain x-rays to have also recently swallowed a watch battery and a small screw. Initial outpatient management with serial review and x-rays was unsuccessful, and delayed inpatient surgical care by 9 days. Although the child never manifested features of systemic or gastrointestinal upset, emergency laparotomy confirmed a resultant jejunocolic fistula. This case demonstrates how clinical assessment of children who have swallowed magnets separately from each other can be falsely reassuring, and highlights the potential dangers of outpatient management. We recommend children who have swallowed separately >1 magnetic objects (or >1 objects capable of magnetic attraction) be managed as inpatients with active observation and timely foreign body removal.