Supermagnet Ingestion An Emerging Paediatric Threat

Sunday, October 27, 2013: 9:00 AM
W311 D (Orange County Convention Center - West Building)
Daniel Rosenfield, MD, University of Toronto, Toronto, ON, Canada

Case Report: /Series:

Supermagnet ingestion – an emerging paediatric threat

Introduction:With the recent development of neodymium-boron-iron magnets, a new, poorly understood threat to paediatric health has emerged. These alloys can produce extremely high magnet forces – typically 10-20 times more than traditional ferrite equivalents.  Since widespread licensing of the technology in the early 2000s, they have gained popularity in children’s toys, in jewelry, and as novelty items such as desk toys.  Public health data has shown an increase in ingestions presenting to community offices and emergency departments. Ingestions of multiple magnets can be particularly dangerous as the magnets may link through loops of bowel causing pressure necrosis.  Without prompt recognition of multiple magnet ingestion, bowel perforation, sepsis, and death can result.  The purpose of our review was to investigate whether or not there has been an increase in magnet ingestion at our institution and any associated morbidity.

Methods:  All foreign body ingestions in the alimentary tract (ICD codes T18.X) seen at our emergency department or transferred directly to our surgical or gastrointestinal service from April 1 2002 to Dec 31 2012 requiring admission or procedural intervention were reviewed for magnet ingestion.  Inclusion criteria included anyone from birth to 18 years with an ingestion of magnet (confirmed by either: parental confirmation of ingestion or direct inspection by medical staff once removed) requiring any procedural intervention and/or hospital admission.

Results: A total of 251 unique patient visits occurred in the 10-year period, and 25 ingestions of magnets were found. The first recorded ingestion occurred in May 2008, with a rise over the subsequent years (2008 n =1, 2009 n = 1, 2010 n= 2, 2011 n = 10, 2012 n = 11) p= 0.02.  The age of patients ranged from 17 months to 13 years, with a mean age of 5.5 years, and median age of 3.8 years.  There were 18 males and 7 females (p = 0.02). Six patients were taken to the operating room to remove the magnets and nine patients had them removed endoscopically. Ten patients were managed conservatively with laxatives and serial observation, either in the ED or at home.   No deaths were reported.

Discussion: In this case series – the largest in the literature – we have shown that magnet ingestion at our institution is a recent phenomenon, and has increased significantly over the past 5 years.  With no cases prior to 2008, clinicians must be aware of the morbidity associated with multiple magnet ingestion, and be knowledgeable regarding the appropriate tenets of management.  With data suggesting that many paediatricians are largely unaware of the dangers of magnet ingestion, health promotion bodies must disseminate information to parents, teachers, physicians and the general public regarding the dangers of these magnets.