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Intra-operative images for one patient. Buckyballs caused intestinal perforation (a) and fistula (b-d)
Source publication
Purpose:
To describe the incidence and management of gastrointestinal tract Buckyball magnets ingestions in a multicenter Chinese pediatric patient population, and discuss the preventive measures.
Methods:
Medical records of 74 pediatric patients from 9 large Chinese hospitals during the past 10 years, who were diagnosed as buckyball magnets ing...
Contexts in source publication
Context 1
... firstly, and if it failed, then operation should be performed. However, if the patient was symptomatic, or the magnets were multiple and beyond the stomach, then operation should be performed directly. Besides, if the patient had only one magnet, then wait-and-see strategy could be taken. During the surgery, gastrointestinal perforation (Fig. 3a), ischemia and necrosis of gastrointestinal wall, abscess, intestinal obstruction, fistula ( Fig. 3b-d) and gastrointestinal mucosa erosion were found (Table 3). The median number of Buckyballs was 4 (IQR 2-8), with a range from 1 to ...
Context 2
... or the magnets were multiple and beyond the stomach, then operation should be performed directly. Besides, if the patient had only one magnet, then wait-and-see strategy could be taken. During the surgery, gastrointestinal perforation (Fig. 3a), ischemia and necrosis of gastrointestinal wall, abscess, intestinal obstruction, fistula ( Fig. 3b-d) and gastrointestinal mucosa erosion were found (Table 3). The median number of Buckyballs was 4 (IQR 2-8), with a range from 1 to ...
Context 3
... were not specific, and were dependent on the time of presentation and location of the Buckyballs, but more than half of the patients (40/74) presented with abdominal pain. Richard Sola Jr. concluded that abdominal pain was one risk factor for emergency surgery [23]. Other complications, such as ischemia and necrosis, gastrointestinal perforation (Fig. 3a), abscess, and gastrointestinal fistula ( Fig. 3b-d) also proved to be critical. Diagnosis and treatment algorithm towards magnets ingestion were published by the NASPGHAN in 2012 [3], and such patients should be managed according to this ...
Context 4
... of presentation and location of the Buckyballs, but more than half of the patients (40/74) presented with abdominal pain. Richard Sola Jr. concluded that abdominal pain was one risk factor for emergency surgery [23]. Other complications, such as ischemia and necrosis, gastrointestinal perforation (Fig. 3a), abscess, and gastrointestinal fistula ( Fig. 3b-d) also proved to be critical. Diagnosis and treatment algorithm towards magnets ingestion were published by the NASPGHAN in 2012 [3], and such patients should be managed according to this ...
Similar publications
Purpose: To describe the incidence and management of alimentary tract Buckyball ingestion in Chinese pediatric patients, and discuss the precautionary measures through a multicenter investigation. Methods: Medical records of 74 pediatric patients from 9 large Chinese hospitals were included in this study. Questionnaires were distributed online, and...
Purpose: To describe the incidence and management of gastrointestinal tract Buckyball magnets ingestions in a multicenter Chinese pediatric patient population, and discuss the preventive measures. Methods: Medical records of 74 pediatric patients from 9 large Chinese hospitals during the past 10 years, who were diagnosed as buckyball magnets ingest...
Citations
... Despite initial regulatory efforts, including a lawsuit against the manufacturer and a federal rule finalized by the U.S. CPSC in 2014, subsequent legal challenges in 2016 overturned the recalls. This reversal has led to a renewed availability of these high-powered magnets on the market and a corresponding increase in related accidents worldwide [2][3][4][5][6][7]. ...
... Intestinal perforation was detected in 50% of cases with multiple magnet ingestions 30 . This is supported by a Chinese study that found gastrointestinal perforation to be the most common complication of multiple magnet ingestions (41.5%) 32,33 . Further, another study also found the small intestine to be the seat of magnet ingestion in 38% of cases 34 . ...
Over the past 15 years, there has been a noticeable uptick in incidents involving children ingesting multiple magnetic foreign bodies which can cause injuries and gastrointestinal complications including death. The current study aimed to identify the prevalence, clinical presentation, and management of single or multiple magnet ingestions. A retrospective multi-central cross-sectional study was conducted to include all pediatric patients < 18 years presented to the emergency department with ingestion of single or multiple magnets and admitted across hospitals in Qatar, UAE, KSA, Tunisia, and Turkey between January 2011 and December 2021. Demographics, symptoms, management, and outcomes were analyzed. There were 189 magnet ingestions, of which 88 (46.6%) were multiple magnet ingestions. Most patients (55.6%) were male, and the median age was 3.9 (IQR 2–7) years. An abdominal X-ray was obtained in all cases. 119 (62%) patients were conservatively treated, 53 (28%) required surgical intervention and 17 (8.9%) underwent gastroscopy. None of the patients with single magnet ingestions experienced morbidity or severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations, perforations (44.3%), severe intestinal necrosis (19.3%), peritonitis (13.6%), severe abdominal infection (10.2%), and septic shock (4.5%). The rate of surgical intervention (59.1% vs. 1.0%) and gastroscopy (15.9% vs. 3.0%) was significantly higher in the multiple ingestion group compared to the single magnet ingestion group. No deaths were identified. A high risk of serious complications, including the need for surgery to remove the magnets and substantial morbidity may result from swallowing more than one magnet. Magnet safety requirements, public education, and improved legislation are urgently required.
... The magnetic balls noted above primarily comprise of neodymium-iron-boron (NdFeB) magnets, a type of artificial magnet with a very strong magnetic force that can attract weights up to 640 times that of their own weight [19]. Tsai et al. [20] found that NdFeB magnets attract one another when they are placed relatively near together (3.5-4.6 cm). ...
Objective
In this study, we aimed to enhance the treatment protocols and help understand the harm caused by the accidental ingestion of magnetic beads by children.
Methods
Data were collected from 72 children with multiple gastrointestinal perforations or gastrointestinal obstructions. The 72 pediatric patients were divided into a perforation and a non-perforation group. The data collected for the analysis included the gender, age, medical history, place of residence (rural or urban), and symptoms along with the educational background of the caregiver, the location and quantity of any foreign bodies discovered during the procedure, whether perforation was confirmed during the procedure, and the number of times magnetic beads had been accidentally ingested.
Results
The accuracy rate of preoperative gastrointestinal perforation diagnosis via ultrasound was 71%, while that of the upright abdominal X-ray method was only 46%. In terms of symptoms, the risk of perforation was 13.844 and 12.703 times greater in pediatric patients who experienced vomiting and abdominal pain with vomiting and abdominal distension, respectively, compared to patients in an asymptomatic state. There were no statistical differences between the perforation and the non-perforation groups in terms of age, gender, medical history, and the number of magnetic beads ingested (P > 0.05); however, there were statistical differences in terms of white blood cell count (P = 0.048) and c-reactive protein levels (P = 0.033). A total of 56% of cases underwent a laparotomy along with perforation repair and 19% underwent gastroscopy along with laparotomy. All pediatric patients recovered without complications following surgery.
Conclusion
Abdominal ultrasonography and/or upright abdominal X-ray analyses should be carried out as soon as possible in case of suspicion of accidental ingestion of magnetic beads by children. In most cases, immediate surgical intervention is required. Given the serious consequences of ingesting this type of foreign body, it is essential to inform parents and/or caregivers about the importance of preventing young children from using such products.
... 5 However, magnet ingestion is unique as in the case of multiple magnets swallowed, they may attract each other across the intestinal wall leading to potential insult in the form of intestinal obstruction, ischemia, and perforation. 6 Globally, a description of magnet ingestion was extremely uncommon in the 1990s, as it only surfaced through case reports in the year 2000. 7 The number of magnet ingestion in pediatrics increased significantly throughout the last 20 years. ...
Abdulaziz Alareefy,1 Esam Barnawi,1 Rawan Alrashed,1 Abdulelah Alamri,1 Ahmed M Aleidan,2 Mazen Alghofaily,3 Mayada Alkhelaif,3 Sara Kanfar4 1Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia; 2Pediatric Pulmonology Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia; 3General Pediatric Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia; 4Pediatric Surgery Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi ArabiaCorrespondence: Abdulaziz Alareefy, Pediatric Emergency Department, King Fahad Medical City, Central Second Health Cluster, Ministry of Health, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia, Email aalareefy@kfmc.med.saAbstract: Swallowing foreign bodies is common in young kids, especially those aged 6 months to 6 years. Magnet ingestion is a hazardous health issue that extremely jeopardizes the most vulnerable group, children, to risks of intestinal obstruction and worse, perforation. We, hereby, report 3 cases of magnet ingestion in the pediatric age group who had multiple beaded magnets stuck inside their GI tract over a variable period of 1 to 10 months before their presentation to the Emergency Department, King Fahad Medical City Riyadh, Saudi Arabia.Keywords: magnet ingestion, pediatric, emergency, foreign body, Saudi Arabia
... Magnetic toys consist primarily of magnetic beads, rods, and cubes, with magnetic beads being the most prevalent. They have vivid colors, high magnetic energy products, and coercive force, demonstrating their potency and the danger they pose to children who accidentally ingest them [6]. The sale of magnetic toys has been strictly regulated in recent years due to societal pressure and the intervention of relevant departments [7]. ...
Background/aims
To investigate the clinical situation, treatment methods, and clinical predictors of surgical intervention in children with magnetic foreign bodies in the digestive tract.
Materials and methods
From January 2019 to June 2022, we retrospectively analyzed the clinical data of 72 children who ingested magnetic foreign bodies inadvertently in our hospital, including their general information, admissions, clinical manifestations, and treatment methods, as well as pertinent literature and statistical data. Following software processing, univariate and multivariate logistic regression analyses were conducted to determine the independent risk factors of this study.
Results
In this study, 16 patients (22.2%) were discharged smoothly following conservative treatment and 19 patients (26.4%) were cured by gastroscopy. The remaining 37 patients (51.4%) were underwent surgery, in which 26 cases developed gastrointestinal perforation. There were statistical differences between surgery group and non- surgery group in the days of eating by mistake, clinical manifestations (nausea and vomiting, intermittent abdominal pain, abdominal muscle tension) and movement trajectory by every 24-h radiograph (P < 0.01). Logistic regression analysis showed that intermittent abdominal pain and abdominal muscle tension were independent risk factors for surgical treatment.
Conclusion
Magnetic foreign bodies seriously endanger children’s health. This study offers a single-center basis for the choice of surgical opportunity for intestinal obstruction or perforation caused by magnetic foreign bodies. Clinicians need immediate surgical intervention if the child shows symptoms of abdominal pain or abdominal tension.
... 6,14 In a multicenter study by Wang et al, perforation was found in 51% of their study population, while ischemia of the bowel was found in 19% of the population. 15 Similar to a single-center study by Zheng et al., who reported single and multiple perforations in 37% of their study population, intestinal perforation was the most prevalent complication detected in our study with 43% of the study population. 16 The rare earth magnets in toys are smaller in size and produce small perforations. ...
... The ingestions are also rarely suspected at this age because of weak communication skills, especially if they go unwitnessed. 15 In 2012, US Consumer Product Safety Commission (CPSC) commenced regulatory activities to limit the sales of rare earth magnets followed by the implementation of a final rule in 2014, launching requirements for the sale of rare earth magnets. 21 ED visits connected to magnet ingestions and hospitalization decreased as a result of the CPSP rule's effects. ...
Introduction:
Rare earth magnets are powerful magnets that can have several negative effects if ingested. The goal of our study is to describe the result of multiple rare earth magnets ingested by children in Qatar.
Materials and methods:
This is observational research. We conducted a retrospective chart review and descriptive analysis of all cases of multiple rare earth magnetic ingestion that werepresented to the Emergency Department of Sidra Medicine between January 2018 and July 2022. We obtained an exemption for this study from our institutional review board (IRB).
Results:
In our research, we identified 21 children having multiple rare earth magnetic ingestions. The predominant symptoms were abdominal pain and vomiting which were observed in 57% (n = 12) and 48% (n = 10) of the patients respectively. The most common sign was abdominal tenderness,observed in 14% (n = 3) of the patients. In our sample, 38% (n = 8) of the patients were managed conservatively whereas 62% (n = 13) needed intervention. In our study, 48% (n = 10) of the patients sustained complications. The frequent complications were intestinal perforation appreciated in 24% (n = 5) and intestinal perforation with fistula formation in 19% (n = 4) of the patients. The median age of these patients was two years while the median number of magnets ingested was six. The ingestions were unwitnessed, and the duration of ingestions was unknowninthemajorityofpatientswhoexperiencedcomplications (n = 8/10).
Conclusion:
If numerous rare earth magnetis ingested, children are in high danger of harm. It can be difficult to pinpoint the cases in younger children due to poor communication skills, especially if the intake is unreported. Although Qatar has established restrictions banning the import of rare earth magnets, there are reported cases of children with rare earth magnets ingestions.
... Gastrointestinal foreign bodies are commonly seen in children, but most (80%-90%) cause no harm and pass out of the alimentary tract without complications (1)(2)(3). However, magnetic foreign bodies are special; multiple magnets can attract each other, which causes particular concerns if they are located in different gastrointestinal regions. ...
... However, they are small and brightly colored, resembling candy (24), and are thus easy for children to swallow. Buckyballs can also attract each other through multiple layers of the gastrointestinal wall, leading to wall injuries as described in a series of literature (2,6,7,24,25). Notably, almost all imaging examinations in these studies were x-ray examinations. ...
... The incidence of magnet ingestion by children has recently increased in China (2). We have great experience in using highfrequency probes to explore the gastrointestinal tract of children, and we previously used such probes to evaluate colonic polyps (26) and Meckel's diverticulum (27), which are widely recognized by clinicians. ...
Background
The incidence of magnet ingestion by children has recently increased in China. Magnet ingestion is associated with an extremely high risk of gastrointestinal damage because loops of bowel can become trapped and squeezed between multiple magnets in different locations. However, the lack of imaging sensitivity makes clinical decision-making difficult.
Objective
This study was conducted to investigate the performance of ultrasound in diagnosing gastrointestinal magnet ingestion in children.
Methods
From April 2017 to February 2021, all children with a history of magnet ingestion or a diagnosis of gastrointestinal magnet as shown by x-ray or ultrasound in our hospital were included as study candidates. Patients who were lost to follow-up or had known malformations of the gastrointestinal tract were excluded. Eligible patients were those with surgical or endoscopic confirmation of gastrointestinal magnet, those who passed the magnet out of the alimentary tract without assistance, and those with confirmed absence of the magnet on abdominal x-ray examination after 1 month of conservative treatment. All eligible patients' ultrasound and x-ray examination data were evaluated. The sensitivity, specificity, and area under the curve (AUC) of ultrasound was calculated for diagnosing magnet ingestion, locating the magnet (stomach, small intestine, or colon), and confirming the phenomenon of wall entrapment.
Results
Of 112 patients, 107 had a magnetic foreign body and 5 did not. Magnets were correctly detected by ultrasound in 97 patients, with an observed sensitivity of 90.65% and specificity of 100%. Satisfactory sensitivity was obtained for ultrasound localization of gastric magnets (96.30%) and small intestinal magnets (100.00%), but sensitivity for ultrasound localization of colonic magnets was relatively poor (73.33%). The discrimination of wall entrapment by ultrasound was good (AUC = 0.93), with an observed sensitivity and specificity of 92.00% and 93.62%, respectively.
Conclusions
Ultrasound can be used to locate gastrointestinal magnets (in the stomach, small intestine, or colon) with good clinical efficacy in identifying wall entrapment.
... The most common ingested foreign body was coin in six studies [22-23, 25, 28, 30-31]. Other reported foreign body materials were buckyballs [24], seeds [26], magnets [27], cigarettes [29] and button batteries [32]. ...
... The presenting complaint to emergency room at the included studies was vomiting in two studies [23,25]. Other symptoms were abdominal pain [24], dyspnea [26], dysphagia [32]. On the other hand, asymptomatic children were the most common in the studies of [22,27,29]. ...
Background: Foreign body ingestion is a predominant worry in pediatric population, with up to 75% of cases happening in childrenyounger than 4 years of age. Pediatric population consume a wide scope of foreign bodies, some of which are more perilous and hazardous than others. Objective: A growing number of research on foreign body ingestion in children nevertheless, there is no clear consensus on signs, symptoms, complications and management of foreign body ingestion among pediatric population. The goal of this systematic review was to determine the significance of foreign body ingestion in pediatric population as far as impaction site, signs and symptoms, and techniques for expulsion. Methods: Authors began with recognizing the important examination proof that spots light on the significance of foreign body ingestion in pediatric population as far as impaction site, signs and symptoms, and techniques for expulsion. We led electronic writing look in the accompanying data sets: Ovid Medline (2015 to present), Ovid Medline Daily Update, Ovid Medline in process and other non-filed references, Ovid Embase (2015 to present), The Cochrane Library (latest issue) and Web of Science. Just examinations in English language will be incorporated. The precise selection was acted in close collaboration with a clinical examination curator. Results: A total of 3503 children with foreign body aspiration were identified from 11 studies (Table in supplementary document). Studies were reported from different places around the world. One study were from Kingdom of Saudi Arabia. Among study participants, there were 2040 males (58.23%) and 1463 females (14.77%). The most common ingested foreign body was coin in six studies. The most common site for impaction of foreign body was esophagus as reported in five studies. Endoscopy was used in as a method of extraction. Conclusion: Children are prone to ingesting foreign bodies. Depending on the type of foreign body, location, and length of impaction, patients may appear asymptomatically or symptomatically with a wide range of symptoms.
... Magnetic-type foreign bodies are of particular concern because they can cause severe injuries to the gastrointestinal tract, which can be life-threatening. As noted, when swallowed alone, they tend to pass through the gastrointestinal tract uneventfully; however, if multiple magnetic foreign bodies are swallowed, they can aggregate in various layers of the intestines, potentially causing ischemia, pressure necrosis, or perforation or volvulus of the intestines, ultimately resulting in a severe situation [19] . The magnetic balls noted above primarily comprise neodymium-iron-boron (NdFeB) magnets, a type of arti cial magnet with a substantially strong magnetic force that can attract weights of up to 640 times that of their own weight. ...
Objective
The objective of this study was to better understand the harm caused by accidental ingestion of multiple beads in children and to improve the consequent management outcomes.
Materials and Methods
Data collected for the analysis of 72 children involved the patient's sex, age, medical history, place of residence (rural or urban) and symptoms, as well as the caregiver's level of education, the location and number of any foreign bodies found during the procedure, whether perforations were confirmed during the procedure, and the number of erroneous ingestion of magnetic beads. Statistical analysis was performed.
Results
There were no statistical differences between the perforated group and the unperturbed group in terms of age, sex, medical history, and number of magnetic beads ingested (P > 0.05). However, there were statistical differences in white blood cell count (P = 0.048) and c-reactive protein levels (P = 0.033), where values were higher in the perforated group than in the non-perforated group.
Conclusion
Abdominal ultrasound and/or abdominal upright x-ray analysis should be performed as soon as possible for rapid diagnosis. Immediate surgical intervention is usually required. Given the serious consequences of ingesting such foreign bodies, it is vital to educate parents and/or caregivers not to keep such products away from young children.
... Ingestion of foreign bodies, including coins, button batteries, bones, needles, and magnets, is one of the common unintentional injuries in children worldwide (1). Buckyball, approximately 5 mm in diameter, with high powered magnet, can steadily attract one another, even though six layers of the bowel wall apart (2,3). Infants and toddlers usually explore objects they can touch via their mouth (4,5). ...
... Ultrasonographys were assessed in 45 cases. The ultrasonography revealed dilated bowel loops with bowel wall thickening, ascites, and sphere metal foreign bodies, which are located in the stomach (14), duodenum (3), small bowel (18), or colon (1), undefined localization (2). The ultrasonographic findings were consistent with the intraoperative or gastroscopic findings in 43 cases (93.33%). ...
... Ingestion of a foreign body is an increasingly common clinical problem, especially in the pediatric population (1). Ingestion of two or more high-powered magnetic Buckyballs with unintentionally severe injury has been reported worldwide in the last decade (2,5,10,16). It occurs most frequently in children aged 1-5 years old (19), and there is male-to-female predominance of 1.3-3.9: 1 (15,16,20). ...
Multiple high-powered magnetic Buckyball ingestions may lead to a high risk of severe complications. Great concerns have been raised by public health workers, and it remains challenging for clinicians to solve this troublesome problem. We report a large case series of children with Buckyball ingestion from six tertiary medical centers. The clinical data, including demographics, medical history, diagnosis tools, management options, intraoperative or endoscopic findings, and outcomes, were retrospectively analyzed. Seventy-one children aged 1–13 years ingested 2–41 Buckyballs. Among them, Buckyballs passed spontaneously on 2–10 days post-ingestion in seven cases; gastroscopic removal was performed in 14 cases; laparoscopic removal in 13 cases; laparoscopic-assisted surgical removal in 6 cases; and open surgical removal in 31 cases. Surgical indications included small bowel obstruction, perforation, peritonitis, acute abdominal pain, or along with ingestion of other metallic foreign bodies. Among those who underwent a surgical procedure, primary intestinal repair was performed in 44 cases, enterectomy with primary anastomosis in 6 cases. The postoperative hospital stay ranged from 5 to 28 days. No major complications occurred. In unwitnessed cases, a vague medical history and nonspecific symptoms usually make the diagnosis difficult. The treatment options should include the watch-and-wait approach, endoscopic, laparoscopic-assisted, or open surgical removal of Buckyballs, with primary intestinal repair or anastomosis. Preventive measures, including children's not having access to Buckyballs, are essential to protect children from this kind of unintentional injury.
