General data
A total of 51 cases were included in this study. The mean age of these cases was 5.3 years. The proportion of male patients was 70.6% (36/51), which was higher than that of female patients. From 2015 to 2019, the number of cases increased (Fig. 2).
Clinical manifestations
The numbers of magnets ingested ranged from two to 24. The ingestion of two magnets accounted for the most (41.2% ,21/51) cases (Fig. 3). Among the 51 cases, the specific time of ingestion of was unknown for six children. The average visit time of the other 45 children was 46.8 hours after their ingestion, ranging from two hours to 14 days. Only 19 cases (37.3%) were symptomatic, including 15 cases of abdominal pain, 12 cases of vomiting, two cases of fever and one case of chest pain. Nine patients had positive signs of abdominal tenderness, and four of them had peritoneal irritation signs (Table 1).
Clinical management
All 51 children had positive foreign body shadows on abdominal plain radiographs, of which two patients showed intestinal obstruction. Six cases also had CT examinations, which showed three cases of intestinal obstruction, one case of intestinal perforation, and two cases of gastrointestinal foreign bodies only.
According to the radiographs, 17 cases’ magnets were possibly still located in the upper digestive tract, so gastroduodenoscopies were performed. By gastroduodenoscopy, the magnets of five cases were removed, of which two cases had no complications, one case had slight mucosal injury and two cases had perforation. In one of these two cases, the location of the perforation was the duodenum, and the patient was subsequently transferred to surgery, underwent duodenal perforation repairment and jejunal nutrition tube placement. After treated by anti-infection and enteral nutrition for 14 days, the patient recovered and was discharged home. The perforation of the other case was in the lower esophagus. After ten days of local drainage and enteral nutrition through a nasojejunal tube, the perforation healed. In six cases, the magnets had passed through the pylorus and entered the lower digestive tract, and the gastric mucosa had mild injury in one of these six cases. In the other six cases, the magnets were still in the upper digestive tract, but they were embedded in the mucosa and could not be removed by gastroduodenoscopy. Therefore, these six cases were transferred to surgery.
In this study, a total of 23 children underwent surgery, including 21 cases of laparotomy and two cases of laparoscopy combined with laparotomy. After the operation, four patients stayed in the ICU for monitoring for two or three days. Twenty-two patients fasted for an average of 7.5 days, ranging from two to ten days. Twenty-two patients had gastrointestinal decompression for an average of 6.8 days, ranging from two to nine days. Sixteen patients had abdominal drainage for an average of 7.8 days, ranging from five to nine days. Eleven patients had fever after surgery for an average of 2.7 days, ranging from one to six days. Twenty-two patients used antibiotics for an average of 11.8 days, ranging from eight to 19 days.
The patients were divided into two groups according to whether they underwent surgery. Compared with the non-surgical group, the surgical group had more male cases; the time from ingestion to arriving at the hospital, fasting time, durations of antibiotics and the length of hospital stay were longer; the peripheral white blood cell count(WBC) and C-reactive protein were higher. . However, there was no significant difference in the mean age or the number of magnets swallowed (Table 2)..
Clinical presentations and outcomes
Among the 51 cases, the magnets passed naturally for 47.1% (24/51), were removed by endoscopies for 9.8% (5/51) and were removed by surgeries for 43.1% (22/51). Twenty-five of them suffered from different degrees of injury (Table 2). In the most serious case, there were 11 intestinal perforations, three segments of intestinal necrosis, and extensive intestinal adhesion. In this study, 39 patients were hospitalized, the average length of hospital stay was 8.8, ranging from one tonine days. Thirty-one patients were undergone surgery, and were followed up for six months, no postoperative complications occurred. No deaths occurred in these cases. We followed all patients for at least six months. There were no long-term complications, such as obstruction or infection.