Clinical predictors of surgical intervention for gastrointestinal magnetic foreign bodies in children

doi:10.21203/rs.3.rs-2079336/v1

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Clinical predictors of surgical intervention for gastrointestinal magnetic foreign bodies in children

https://doi.org/10.21203/rs.3.rs-2079336/v1

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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, and the receiver operating characteristic curve (ROC) was used to evaluate their predictive performance.

Results: Among the 72 children who accidentally ingested magnetic foreign bodies, 59 (86.8%) ingested foreign bodies, with an average of 3.42 days and 11.03 foreign bodies. The predominant symptoms were nausea and vomiting. 19 cases (31.2%), 33 cases (54.1%) with abdominal pain; 9 cases (14.8%) with peritoneal irritation; 13 cases (21.3%) within 24 hours with foreign body movement. Treatment: conservative in 16 cases (22.2%), gastroscope in 19 cases (26.4%), and surgery in 37 cases (51.4%), with gastrointestinal perforation occurring in 26 cases (70.3%). ROC (AUC = 0.808) for predicting surgical treatment plans for children with magnetic foreign body ingestion.

Conclusion: We found that nausea、vomiting and intermittent abdominal pain significantly increased the likelihood of surgical treatment in children undergoing surgery.

magnetic foreign body

timing of surgery

complications

One of the significant causes of accidental injury in children is ingesting foreign bodies through the digestive tract, primarily because children have a limited ability to perceive things and an intense curiosity.¹ For treating foreign bodies in the digestive tract, conservative self-discharge, gastroscopic removal, and surgical procedures are currently the most common options. According to pertinent statistics, over 80% of cases of oral ingestion of foreign bodies are treated conservatively, and only 1% of children require surgical intervention.². Common types of foreign surgical bodies include magnetic foreign bodies and button batteries. Different types, quantities, and shapes of foreign bodies also result in distinct complications. Suppose a child accidentally consumes a large quantity or multiple batches. In that case, the magnetic substances may attract each other in the digestive tract, leading to hypoxia-induced extrusion of the gastrointestinal tract wall, intestinal necrosis, perforation, obstruction, or formation of a fistula.³ In the absence of timely surgical intervention, volvulus can develop; in severe cases, toxic shock could occur, which may be life-threatening. Due to the slow development and hidden nature of magnetic foreign body disease in the digestive tract, early diagnosis, selection of appropriate treatment methods, and determining the timing of surgery are crucial. Current literature reports and diagnosis and treatment guidelines do not straightforwardly explain the selection of the timing of magnetic foreign body surgery. Numerous factors are associated with the surgical intervention of children who ingest magnetic foreign bodies by accident, so this study retrospectively analyzed the children's clinical data and other factors. Through pertinent data, we can predict the relevant factors of surgical intervention and provide a foundation for clinical diagnosis and treatment.

Clinical data

Seventy-two children admitted to our hospital between January 2019 and August 2022 due to the accidental ingestion of magnetic foreign bodies were chosen as the research subjects. It was reviewed and approved by the Children's Hospital Affiliated with Soochow University's Ethics Committee（NO.2022CS153）. According to the treatment method, all children were divided into operation and non-surgery groups and the admission situation of the two groups was analyzed.The relevant data were analyzed and presented. The study was approved by the institutional review board of Children’s Hospital of Soochow University. The authors have identified the institutional and/or licensing committee approving the experiments, including any relevant details; confirming that all experiments were performed in accordance with following relevant guidelines and regulations. Informed consent was waived by the institutional board of Children’s Hospital of Soochow University as a retrospective study is performed.

Inclusion and exclusion criteria

Inclusion criteria: there must be a clear history of ingestion of magnetic foreign bodies, or endoscopy, imaging, and surgery must indicate the presence of magnetic foreign bodies.

Exclusion criteria: the foreign body in the digestive tract is non-magnetic, and the patient cannot cooperate due to other issues.

Observation index

The relevant clinical data of all children who accidentally ingested magnetic foreign bodies include age, gender, time from onset to consultation, primary symptoms, type of accidental ingestion, number of accidental ingestions, supplementary examination, treatment method, complications, and prognosis.

Statistical analysis

By examining the inpatient medical records, a database was established. Excel was utilized to establish a database. Two individuals entered data, which a third person reviewed. The statistical analysis was conducted with SPSS 17.0. Various statistical methods were used to analyze the data. Normally distributed data in measurement data were expressed as mean ± standard deviation (x ± s), and comparisons between groups were made using an independent samples t-test. Skewed distribution data were expressed as median numbers and interquartile ranges, and comparisons between groups were made using the Mann-Whitney U test. Enumeration data were expressed as n (%), and χ2 test or Fisher's test was utilized for group comparison. All statistical tests were two-sided, and P values < 0.05 were considered statistically significant. Among the relevant risk factors compiled are univariate logistic regression analysis. To exclude confounders and include all relevant risk factors, all factors with P < 0.1 were included in multiple logistic regression analysis. This study’s final statistically significant (P < 0.05) factor was an independent risk factor. Utilizing receiver operating characteristic (ROC) curves, the performance of the derived models was evaluated.

Admission and treatment of children who ingested magnetic foreign bodies

The collected case information was categorized and summarized according to admission years and treatment methods. See Table 1 for details. In our hospital, the incidence and cost of gastrointestinal foreign bodies in hospitalized children ranged from 54 to 88 cases per year. In the first half of 2022, there were 54 cases of foreign bodies in the digestive tract, of which 11 (20.4%) were magnetic foreign bodies. The specific data are depicted in Figure 1.

Table 1

Admission and treatment of children who mistakenly ingested magnetic foreign bodies.

Year	Total number of cases (cases)	Conservative treatment (cases)	Gastroscopy removal (cases)	Surgical treatment (cases)	Proportion of surgical interventions
2019	14	2	4	8	57.14%
2020	21	4	4	13	61.90%
2021	26	8	7	11	42.31%
2022 (as of June)	11	4	2	5	45.45%
Total	72	18	17	37	51.39%

Magnetic foreign bodies in the gastrointestinal tracts of children: prevalence and clinical manifestations

In the cases, vomiting, persistent abdominal pain, diarrhea, and parental findings or self-reported ingestion of magnetic beads were the most common reasons for medical treatment; the most common clinical manifestations were nausea and vomiting (42.62%), persistent abdominal pain (57.38%), abdominal muscle tension (13.11%), local mass (3.28%), local tenderness (27.87%), and poor spirit (3.28%). Refer to Figure 2. To further confirm the diagnosis, the upright abdominal X-ray is frequently utilized in the clinic as the preferred supplementary examination. This study's abdominal X-ray examination can detect foreign bodies in the gastrointestinal tract. Figure 4 demonstrates the typical X-ray findings.

A comparison of treatment strategies for children who ingested magnetic foreign bodies

In the cases included in this article, magnetic foreign bodies in the digestive tract are primarily treated with observation, gastroscope removal, and surgery. There were 37 surgical intervention cases (51.39%) and 35 non-surgical intervention cases (48.61%). Age, gender, ingested number by mistake, local tenderness on physical examination, and mass did not differ between the two groups. As for statistical significance, on the contrary, there were statistically significant differences between the groups regarding the time of ingesting by mistake, clinical manifestations (e.g., nausea, vomiting, persistent abdominal pain, abdominal muscle tension) and 24-hour radiograph movement (P < 0.05). The information is presented in Table 2.

Table 2

Comparison of clinical data between the surgical and non-surgical groups.

	Surgery group（n=39）	Non-surgical group（n=33）	Z/c²	p
Age/Year ·	4.00（3.00，5.00）	5.00（3.00，8.50）	-1.33	0.184
Gender
Male:Female *	3.6:1	4.6:1	0.13	0.910
Accidental ingestion time/day·	2.00（1.00，4.00）	0.72（0.23，1.63）	-3.55	0.001¨
Accidental ingestion number/capsule ·	7.00（5.00，10.75）	5.00（3.00，9.00）	-1.515	0.130
Clinical manifestations
Nausea *	15	7	7.193	0.007¨
Vomiting *	15	7	6.696	0.010¨
Intermittent abdominal pain*	28	8	6.771	0.001¨
Abdominal muscle tension *	15	0	6.436	0.011¨
Local mass *	1	1	0	1．000
Local tenderness *	13	5	3.349	0.067
24-hour radiograph movement *	0	17	15.815	0.001¨

Note: Items with "*" used chi-square test for data analysis, and data are described above by frequency; items with "·" used Mann-Whitney U test, and data are described above by median (interquartile range). Finally, items with “¨” refer to P < 0.05, which denotes statistical significance

Analysis of factors related to surgical intervention of magnetic foreign bodies in children's digestive tract

Initially, univariate analysis was performed. Magnetic foreign bodies in the digestive tract are associated with accidental eating time, clinical manifestations (nausea, vomiting, persistent abdominal pain, abdominal muscle tension), and 24-hour radiograph movement related to surgical procedures. Therefore, significant univariate factors were included in the multivariate logistic regression analysis, excluding confounding variables. In children with magnetic foreign bodies in the digestive tract, nausea、vomiting and intermittent abdominal pain are independent risk factors for surgical intervention. See Table 3 for details. Figure 3 depicts the ROC curve (AUC = 0.808) of the prediction model for intermittent abdominal pain resulting from surgical removal of gastrointestinal magnetic foreign bodies.

Table 3

Logistic regression analysis of factors related to surgical intervention for magnetic foreign bodies in the gastrointestinal tract.

	Univariate regression analysis			Multivariate regression analysis
	OR	95%CI	P	OR	95%CI	P
Accidental ingestion time/day	0.890	0.764-1.035	0.130
24-hour radiograph movement	1.350	0.004-0.299	0.002¨
Clinical manifestations
Nausea	4.952	1.239-19.789	0.024¨
Vomiting	5.000	1.606-15.566	0.005¨
Intermittent abdominal pain	6.667	1.816-16.810	0.003¨	1.177	0.834-1.918	0.039¨
Abdominal muscle tension	0.090	0.018-0.040	0.003¨	18.417	2.115-20.976	0.008¨

Note: Items with “¨” refer to P<0.05, which is statistically significant.

Digestive tract perforation resulting from magnetic foreign bodies in the gastrointestinal tract

For 26 (42.6%) of the 61 children with magnetic foreign bodies in the gastrointestinal tract, gastrointestinal perforation and the formation of an internal fistula were present. Most perforations occur in the ileum, colon, or stomach. The information is provided in the table below.

Table 4

Clinical data of some children with perforation caused by magnetic foreign bodies in the digestive tract

No.	Gender	Age	Type of foreign body	Accidentally ingested	Accidental ingestion time (d)	Complaint	Physical examination	Treatment	Perforation location
1	Male	7	Magnet	8	1.2	Abdominal pain with vomiting for more than 1 day	Abdominal muscle tension, umbilical and lower abdominal tenderness	Laparoscopic surgery converted to open surgery	Small intestine and ascending colon
2	Male	4	Magnetic beads	6	3	Abdominal pain with vomiting for more than 1 day	-	Laparoscopic surgery converted to open surgery	2. Small intestine
3	Male	5	Magnetic beads	3	3	Intermittent abdominal pain for more than 12 hours	-	Laparoscopic surgery converted to open surgery	2. Small intestine
4	Female	1	Magnetic beads	28	3	Vomiting for more than 8 hours	Abdominal mass	Laparoscopic surgery converted to open surgery	4，Small intestine and small intestine, intestinal wall of jejunum and transverse mesocolon, and posterior wall of stomach
5	Male	3	Magnetic beads	69	15	Intermittent abdominal pain for more than half a month, falling from a height for more than 4 hours	-	Laparoscopic surgery converted to open surgery	Jejunum and transverse mesocolon and back wall of stomach
6	Female	3	Magnetic beads	7	30	Abdominal pain with fever for 2 days	Abdominal distention with palpable tenderness in the upper abdomen	Laparoscopic surgery converted to open surgery	1，small intestine with heavier adhesions
7	Male	12	Magnetic beads	3	1.9	4 days of ingestion of foreign bodies, abdominal pain and anorexia for more than 1 day	lower abdominal tenderness	Laparoscopic surgery converted to open surgery	1，back wall of stomach and part of jejunum
8	Male	2	Magnetic beads	25	2	Intermittent abdominal pain for more than 2 days	-	Laparoscopic surgery converted to open surgery	3 places Adhesion between the middle jejunum and the transverse colon; the ascending mesocolon can be perforated, extending backward to the descending part of the duodenum, and the descending part of the duodenum can be perforated about 0.8cm*0.8cm
9	Male	4	Magnet	5	15	Persistent abdominal pain for 3 hours	local tenderness	Laparoscopic surgery	1. Adhesion of the small intestine 100cm away from the ileocecal region and the ascending colon 10cm away from the ileocecal region
10	Male	3	Magnetic beads	5	2	1Accidentally swallowed magnetic beads for more than 2 days	-	Laparoscopic surgery	1 ileum and ileocecal 5cm away from the ileocecal
11	Male	3	Magnetic beads	20	1.91	Accidentally swallowed magnetic beads for more than 46 hours	-	Laparoscopic surgery	1 ileum
12	Male	4	Magnetic beads	4	Unknown	Abdominal pain with repeated vomiting for two days	local tenderness	Laparoscopic surgery converted to open surgery	1. 80cm away from the ileocecal area
13	Male	3	Magnetic beads	5	Unknown	Vomiting for 4 days with diarrhea	Abdominal distention with palpable tenderness in the upper abdomen	Laparoscopic surgery converted to open surgery	1 distal and proximal bowel perforation
14	Male	9	Magnetic beads	10	0.21	Accidentally swallowed magnetic beads for more than 4 hours	-	Laparoscopic surgery	About 5cm from the ileocecal area
15	Male	1	Magnetic beads	3	Unknown	Vomiting for 2 days with fever	-	Laparoscopic surgery converted to open surgery	1，small intestine with heavier adhesions
16	Female	4	Magnetic beads	8	Unknown	Intermittent abdominal pain for more than 4 days	-	Gastroscope combined with laparoscopic surgery	1 gastric perforation and intestinal perforation through the transverse mesocolon to form an endoleak
17	Male	3	Magnetic beads	11	0.5	Accidentally swallowed magnetic beads for more than 12 hours	-	Laparoscopic surgery converted to open surgery	3，small bowel perforations 2 small bowel perforations 1 mesenteric perforation
18	Female	9	Magnetic beads	10	30	Accidentally swallowed magnetic beads for more than 3 months, abdominal pain for more than 2 days	Slight muscle tension in the whole abdomen, tenderness in the whole abdomen	Laparoscopic surgery converted to open surgery	2 jejunum perforation, transverse colon perforation
19	Male	4	Magnetic beads	5	2	Abdominal pain with vomiting for more than 1 day	poor spirit、tight abdominal muscles、local tenderness	Laparoscopic surgery converted to open surgery	1 perforation was Meckel’s diverticulum
20	Male	9	Magnetic beads、Magnet	3 magnetic blocks 4 magnetic beads	Unknown	Intermittent abdominal pain for more than 15 hours	Right abdominal tenderness	Laparoscopic surgery converted to open surgery	2. Two adjacent internal fistulas formed at the adhesion position of stomach and colon
21	Male	13	Magnet	2	Unknown	Abdominal pain with vomiting for more than four days	-	Laparoscopic surgery converted to open surgery	2 ileal and colonic intestinal necrosis and perforation
22	Male	5	Magnetic beads	2	Unknown	Intermittent abdominal pain with vomiting for five days	The abdomen was slightly distended, and the left abdominal tenderness was obvious.	Laparoscopic surgery converted to open surgery	2 jejunal necrosis perforation
23	Male	4	Magnetic beads, button battery	11 Magnetic beads, 2 button battery	Unknown	Intermittent abdominal pain with vomiting for three days	tight abdominal muscles、local tenderness	Laparoscopic surgery converted to open surgery	4 jejunal and ileal perforations
24	Male	4	Magnetic beads	8	1	Abdominal pain over 6 hours with vomiting 3 times	Normal mental response, slightly distended abdomen	Laparoscopic surgery converted to open surgery	2 small intestine and mesentery
25	Female	1	Magnetic beads	28	3	Swallowing magnetic beads with vomiting for more than 3 days	Abdominal muscle tension, local tenderness	Laparoscopic surgery converted to open surgery	1 small intestine
26	Female	1	Magnetic beads	2	1	Repeated vomiting for 11 hours	Poor spirit, abdominal muscle tension, local tenderness	Laparoscopic surgery converted to open surgery	1 small intestine

Foreign bodies in the gastrointestinal tract are one of the most common causes of pediatric surgical emergencies and are most prevalent in young children. The primary reason is that children's range of activities expands, their curiosity grows, and their capacity for discrimination diminishes during this time.⁴ Simultaneously, coordination of swallowing movements is limited, and the protective reflex of the throat is not yet fully developed. Nine (12.5%) of the 72 children in this study were younger than one year, 26 (36.11%) were younger than three years, and 55 (76.4%) were younger than six years, with a male-to-female ratio of 3.69:1. It is consistent with the results of the 2015 U.S. Epidemiological Survey on Foreign Bodies in the Digestive Tracts of Children regarding the age and gender ratios.⁵ Foreign bodies commonly found in children include coins, toys, and jewelry. More than 80% of foreign bodies in the digestive tract have no clinical manifestations in clinical practice and can be expelled without special treatment, according to research. Magnetic toys consist primarily of magnetic beads, rods, and cubes, with magnetic beads being the most prevalent. The magnetic beads are composed entirely of magnetic materials. They have a diameter of approximately 5 mm, vivid colors, high magnetic energy products, and coercive force, demonstrating their potency and the danger they pose to children who accidentally ingest them.⁶ As a result, the time of ingestion of magnetic foreign bodies, the number of ingestions, and the swallowing situation vary, resulting in various clinical manifestations in children.⁷ The sale of magnetic toys has been strictly regulated in recent years due to societal pressure and the intervention of relevant departments. According to the data analysis results of this single center in our hospital, the number of children with magnetic foreign bodies has not decreased significantly, and the trend is upward. Therefore, the diagnosis, treatment, and prevention of magnetic foreign bodies in children's digestive tracts are crucial.

1. Clinical manifestations of accidental ingestion of magnetic foreign bodies in the digestive tract

Magnetic foreign bodies in the digestive tract of children are a relatively common and highly unique category of foreign bodies in the digestive tract that are primarily determined by their physical characteristics. The most prevalent variety is magnetic beads. Accidental ingestion of a single magnetic foreign body typically results in few clinical manifestations, and most are excreted naturally. However, it dramatically increases the likelihood that the gastrointestinal tract, mesentery, and other tissues will be compressed. Prolonged ischemia will cause necrosis, perforation, and fistulas in the gastrointestinal tract. In this group of children with magnetic foreign bodies in the digestive tract, the number of accidental ingestions ranged from 2 to 95, with the most extended duration exceeding one month. Consequently, the severity of the clinical manifestations varies, and there are no typical manifestations. Common symptoms include intermittent abdominal pain, nausea and vomiting, abdominal distension, and diarrhea. Severe cases can rapidly develop life-threatening intestinal obstruction, peritonitis, and shock. In this study, the most prevalent clinical manifestations included abdominal pain (54.1%), nausea and vomiting (31.1%), peritonitis (8.2%), and fever (3.3%).

Neither is the physical examination of these children typical. Previous research has demonstrated that magnetic beads attract one another and rarely cause abdominal leakage. The primary cause of the symptoms is intestinal obstruction. These children develop internal fistulas because of long-term perforation. Compression of the intestinal tube leads to intestinal root obstruction in a closed intestinal loop. The primary physical examination symptoms are abdominal distention, intestinal type, entire abdominal tenderness, and even rebound tenderness.

2. Selection of examination methods

The most common clinical imaging examination is a chest and abdomen X-ray, which frequently reveals multiple high-density shadows distributed in a beaded or clumpy pattern. Multi-angle abdominal X-ray photography can effectively identify the number of foreign bodies (Fig. 4a), and 24-hour dynamic abdominal X-ray monitoring is the current "gold standard" for clinical guidance. When the location of the foreign body is uncertain, abdominal CT can be utilized to provide clarity. Unfortunately, abdominal B-ultrasound is not specific for diagnosing magnetic foreign bodies in the digestive tract, resulting in a high rate of missed diagnoses. The type of perforation caused by magnetic foreign bodies in the digestive tract is uncommon, and it typically has a small diameter and is predominantly an internal fistula. Therefore, abdominal X-rays reveal less free gas under the diaphragm.⁸ Figs. 4b and 4c depict typical X-ray images.

3. Diagnosis and treatment of ingestion of magnetic foreign bodies in digestive tract

A complete and comprehensive medical history is essential for diagnosing and treating this type of illness. Children who ingest magnetic foreign bodies inadvertently typically have a clear history of exposure to magnetic foreign bodies. Unfortunately, time is not adequately described. Consequently, the diagnosis of accidental ingestion of magnetic foreign bodies in the digestive tract is frequently based on clinical manifestations combined with imaging examinations, with abdominal X-ray being the most important (frontal and lateral view). It is intuitively reflected and provides practical assistance in selecting follow-up treatment options.

Presently, the most frequently used clinical treatments for magnetic foreign bodies in the digestive tract are the self-discharge of foreign bodies, gastroscopy, laparoscopic foreign body removal, and laparoscopic foreign body removal. This study categorized treatment methods as surgical treatment (laparoscopic surgery, open surgery) or non-surgical treatment (conservative, gastroscopic removal). In the guidelines for diagnosis and treatment, neither the choice of treatment nor the timing of surgery is detailed. As the standard, abdominal X-ray's clinical manifestations and dynamic changes are the most intuitive clinical method.

As depicted in Fig. 5a, it is prudent to closely monitor the dynamic changes of foreign bodies on abdominal X-rays for children who simultaneously ingest one or a small number of magnetic foreign bodies. According to the diagnosis and treatment guidelines proposed by the European Society of Gastrointestinal Endoscopy in 2017, foreign bodies can be removed under a gastroscope from children who have swallowed them by accident or if the foreign body is in the duodenum or above within 24 hours. If the gastroscope cannot be removed entirely, the foreign body's dynamic changes should be closely monitored, and surgery should be performed if it remains for an extended period.⁹ The specific operations are as follows: attain the requirements of general anesthesia and fasting before surgery, and electrolyte rehydration is contiguously given to maintain the homeostasis of the internal environment, while preventive antibiotics are utilized. After tracheal intubation and successful anesthesia, the patient was positioned in a lateral decubitus position. The gastroscope is inserted through the mouth to observe the epiglottis and esophagus. After entering the stomach, remove gastric fluid using suction. If a bead-like magnetic foreign body is observed, a disposable net bag or gastroscope grasping forceps can be implanted through the operation port for intubation or grasping. After the foreign object was removed orally, the gastroscope was used to examine the stomach and duodenum. If there was no anomaly, the stomach gas was aspirated, and the gastroscope was removed. As depicted in Fig. 5b, the number of foreign bodies was thoroughly examined. In this study, a gastroscopy was performed on 16 children, and the success rate was 68.75%, which has the benefits of a high success rate, minimal damage, and low cost.

With the development of surgical gastrointestinal endoscopy in our hospital, it is now the norm to actively perform gastroscopy and combined gastroscopy and laparoscopy to remove magnetic foreign bodies from the digestive tract.¹⁰ Immediate surgical treatment should be administered to patients who did not respond to gastroscopy removal, those with obvious signs of peritoneal irritation, and those with confirmed gastrointestinal magnetic foreign bodies and unstable vital signs. Some scholars believe that laparotomy should be the first choice for surgical intervention.¹¹ We agree that laparoscopic exploration should be the first choice for surgical intervention, primarily because it is not only a surgical method but also a visual inspection. Laparoscopic exploration can assist in diagnosing patients who cannot identify the location of the foreign body on an abdominal X-ray and who are unable to judge the necrosis and perforation¹² (Fig. 6a,b,c).In comparison to traditional laparotomy, laparoscopic surgery causes less damage. Simultaneously, it is possible to enlarge the umbilical incision and remove the free intestinal tube that is absorbed only by foreign bodies. The intestinal canal of an internal fistula can also be used to locate the abdominal wall incision more precisely, thereby preventing blind expansion of the incision. When there is apparent necrosis and perforation, or the endoscopic procedure is complex, it should be converted to laparotomy in time to ensure a smooth and smooth operation of the digestive tract (stomach to rectum) to prevent missed perforation sites. In this study, 21 instances of laparoscopic surgery were converted to open surgery, accounting for 65.6% of all surgical procedures. Laparoscopic exploration frequently reveals necrosis, perforation, or the formation of an internal fistula due to the absence of a clear opportunity for surgical intervention, which is the primary cause of its high incidence. This study sorted and counted all cases' general and clinical data based on this clinical treatment method. The results demonstrated that following the theory, intermittent abdominal pain is an independent risk factor for surgical removal of magnetic foreign bodies from children's digestive tracts¹² (Fig. 6d,e,f).

4. Complications and prognosis of the ingestion of magnetic foreign bodies in the digestive tract

Complications caused by magnetic foreign bodies in the digestive tract of children frequently have a direct bearing on their treatment, hospital stay, hospital costs, and prognosis.¹³ The principal complications include mucosal edema, erosion, intestinal necrosis, perforation, bleeding, and intestinal obstruction, with gastrointestinal perforation being the most prevalent. In this study, perforation of the digestive tract accounted for 59.1% of cases, as shown in Table 4. Among them, patient no. 19 was found to have Meckel's diverticulum during the operation. Upon perforation, he underwent "Meckel's diverticulum excision, gastrointestinal foreign body removal, intestinal adhesion release, enteroenteric anastomosis, and abdominal drainage," and the postoperative recovery was acceptable. Patient no(Figure 5c). 09 was found to have "Cunning magnetic beads" during the operation, specifically in the descending part of the duodenum, penetrated the ascending mesentery after perforation, and subsequently performed "digestive tract foreign body removal and intestinal perforation repair." Patient no. 23 ingested magnetic beads and button batteries by accident. Due to the high corrosiveness of button batteries, the degree of intestinal adhesion during the operation was severe, and most of the intestinal tubes were necrotic. The child developed intestinal obstruction after the surgery but gradually improved with conservative treatment. According to the prognosis survey of all children in this study, most children have been completely cured, and there were two cases of postoperative intestinal obstruction, accounting for 3.28%.^14,15

In conclusion, the damage caused by magnetic foreign bodies in children's digestive tracts is highly severe, so prevention is frequently preferable to treatment. Therefore, we should urge the social level to actively promote education, discourage the use of magnetic toys, and remind relevant manufacturers to create visible signs. Awaken all parents and safeguard children from contact. Medical personnel must actively adopt a treatment plan for children who have ingested by accident, prioritizing the use of gastroscope removal or gastroscope combined with laparoscopy to improve the foreign body removal rate, reduce the incidence of complications, and ensure the safety of children's lives.^16,17

Author contributions

Y.R.Z. have made substantial contributions to the conception of the work and drafted the work; approved the submitted version the acquisition; agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work. P.C、J.Z、L.H.C、W.H.Z、L.Y.J.has made substantial contributions to the conception, acquisition, analysis, and interpretation of data of the work. Approved the submitted version the acquisition; agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work. T.T.Z、L.M.Z、Q.W、G.X.Z、L.X.X、L.F.H.has substantively revised the manuscript; approved the submitted version the acquisition; agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work. W.Z.Z、C.Z.G has made substantial contributions to the conception; the acquisition, analysis, and interpretation of data; approved the submitted version the acquisition; agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work.

Competing interests

The authors declare no competing interests.

Additional information

The datasets used and analysed during the current study available from the corresponding author on reasonable request.

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No competing interests reported.

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Clinical predictors of surgical intervention for gastrointestinal magnetic foreign bodies in children

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Abstract

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Introduction

Materials And Methods

Results

Discussion

1. Clinical manifestations of accidental ingestion of magnetic foreign bodies in the digestive tract

2. Selection of examination methods

3. Diagnosis and treatment of ingestion of magnetic foreign bodies in digestive tract

4. Complications and prognosis of the ingestion of magnetic foreign bodies in the digestive tract

Declarations

References

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