Dong Yan1, Xiaona Xia2, Fei Rong1, Haipeng Zhou3, Penghui Wei4. 1. Shandong University, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Department of Anesthesiology, Qingdao, China. 2. Shandong University, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Department of Radiology, Qingdao, China. 3. Shandong University, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Department of Anesthesiology, Qingdao, China. Electronic address: hope6968@hotmail.com. 4. Shandong University, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Department of Anesthesiology, Qingdao, China. Electronic address: weipenghuihui@sina.com.
Accidental ingestion of magnetic foreign bodies is a common pediatric problem attributed to the increasing availability of magnetic toys. A single magnet ingestion may be harmless; however, swallowing of numerous magnets can lead to catastrophic consequences. The image from a 4-year-old boy following ingestion of 36 magnetic beads showed a tight intact beaded “pearl necklace” appearance located in the right abdomen (Fig. 1). The ingestion and possible magnetic beads interaction across the intestinal wall propose the risk of pressure-induced intestinal necrosis with forces up to 1,300 G, contributing to subsequent obstruction, fistulation, perforation, and even toxic shock.
Figure 1
The figure showed a tight intact beaded “pearl necklace” appearance located in the right abdomen in a 4-year-old boy following ingestion of 36 magnetic beads.
The figure showed a tight intact beaded “pearl necklace” appearance located in the right abdomen in a 4-year-old boy following ingestion of 36 magnetic beads.Urgent removal often requires the use of general anesthesia and is recommended in all cases of multiple magnet ingestion, unlike the expectant approach performed in the majority of foreign body ingestion. For the urgent removal, a rapid-sequence anesthesia induction and endotracheal tube should be preferred due to a possibility of a full stomach and the need to secure the airway. Although magnetic beads are radio-opaque and abdominal radiography is the best choice for diagnosis, ultrasound-guided fast evaluation conducted by anesthesiologists may be more helpful in determining the location of magnets before skin incision in emergency laparoscopic surgery. Considering the potential serious complications, including septic shock from intraperitoneal infection and significant intraprocedural hemorrhage owing to the erosion of mesenteric vessels between the magnets, large bore intravenous access for rapid infusion and an arterial line for monitoring real-time hemodynamics should be preoperatively obtained. Patients with complications may be appropriately transferred to the intensive care unit intubated and sedated for further treatment after surgery. The written informed consent was obtained from the patient’s guardian.
Funding
This work was funded by the Natural Science Foundation of Shandong Province (ZR2020QH291), the Qingdao Key Health Discipline Development Fund (2019) and the Scientific Research Foundation of Qilu Hospital of Shandong University (Qingdao) (QDKY2020QN04).
Figure 1