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Indian Pediatr 2015;52: 536 |
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Single Magnet Ingestion – Individualizing the
Algorithm
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*Barath Jagadisan and Niranjan Biswal
Department of Pediatrics, JIPMER, Puducherry, India.
Email: [email protected]
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We present a case that encouraged us to revisit the management algorithm
in single magnet ingestion [1]. A child had undergone a double-barrel
sigmoid colostomy for anorectal malformation during neonatal period,
with a plan for staged surgical repair. At four years of age he
presented to the surgeon after ingestion of a single small magnet. The
magnet was visible in the epigastrium on radiography. Being
asymptomatic, serial radiological follow-up was advised, but the parents
did not report for follow-up. Five months later, the child presented
with frequent colicky abdominal pain and bloating which used to subside
with passage of stools. On examination, the abdomen was soft, and stoma
was extremely tight allowing only the tip of the little finger resulting
in oozing of blood. Anteroposterior radiograph revealed a magnet on the
left side of the abdomen. A 9.2 mm esophagogastroduodenoscope was
inserted through the stoma into the proximal loop with difficulty, and a
1.5 cm magnet was visualized proximal to the stoma. Attempts to remove
it with rat-tooth forceps led to repeated slipping as the stoma was
narrow. A net retrieval device was used, and the magnet could be removed
only with significant force that damaged the net. There was self-limited
oozing from the stoma. The child became asymptomatic after removal of
the foreign body.
The literature cites symptomatic retention of sharp
or large blunt foreign bodies in patients with altered bowel anatomy
(congenital/acquired disorder or consequent to a surgery) [2-4]. We
could find only one report of a retained small blunt foreign body,
attributable to a surgical alteration of anatomy [5].
The decision to conservatively follow-up a single
ingested magnet in the index case was probably in accordance with a
published algorithm for single magnet ingestion [1].
A narrow colostomy, even if asymptomatic, can lead
to symptomatic retention of small foreign bodies. Prolonged magnet
retention is undesirable as injury might result from ingestion of a
second ferromagnetic object or clothing with iron accessories [1]. If
prolonged passage or retention is anticipated, based on medical
(motility disorders) or surgical problems (stenosed/small stoma,
strictures), early gastroscopic removal of magnets may be advisable.
Also, decisions on conservative follow-up are best made considering the
constraints for frequent healthcare visits (geographical separation or
distance). Conservative management and later trans-stomal endoscopy
(with or without prior dilatation) through a stenosed stoma may invoke
fibrosis and increase in stenosis [6].
Algorithms for conservative follow-up of single
magnets should be revised in special situations and tailored to
individual patient conditions and circumstances.
References
1. Hussain SZ, Bousvaros A, Gilger M, Mamula P, Gupta
S, Kramer R, et al. Management of ingested magnets in children. J
Pediatr Gastroenterol Nutr. 2012;55:239-42.
2. Macmanus JE. Perforations of the intestine by
ingested foreign bodies: Report of two cases and review of the
literature. Am J Surg. 1941;53:393-402.
3. Benjamin SB. Small bowel obstruction and the
Garren-Edwards gastric bubble: an iatrogenic bezoar. Gastrointest Endosc. 1988;34:463-7.
4. Haiart DC. An unusual complication of stenosis of
a colostomy. Postgrad Med J. 1985; 61:549-50.
5. Ng KC, Mansour E, Eguare E. Retention of an
ingested small blunt foreign body. JBR-BTR. 2011;94: 339-42.
6. Husain SG, Cataldo TE. Late stomal complications. Clin Colon
Rectal Surg. 2008;21:31-40.
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