Cho Jinbeom, Sung Kiyoung, Lee Dosang
Department of Surgery, The Catholic University of Korea, College of Medicine, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
Department of Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, Uijeongbu-si, 11765, Republic of Korea.
BMC Surg. 2017 Jun 24;17(1):73. doi: 10.1186/s12893-017-0269-z.
Although foreign bodies (FBs) typically pass spontaneously and uneventfully through the digestive tract, a subset of such bodies may become trapped, eventually leading to significant injury. In particular, the ingestion of magnetic materials can cause serious morbidity due to proximate attraction through the intestinal wall.
We recently treated three pediatric patients who had ingested several magnetic foreign materials. None of these patients exhibited any clinical symptoms or signs suggestive of surgical abdomen. Moreover, it was difficult to determine a definite diagnosis and a treatment plan due to limitations in history taking and radiologic examination. After admission to the hospital, these patients underwent surgery for the following reasons: (1) failure to spontaneously pass ingested foreign materials; (2) sudden-onset abdominal pain and vomiting during hospitalization; and (3) gastric perforation incidentally discovered during gastroduodenoscopy. Subsequently, all patients were discharged without complications; however, their conditions might have been fatal without surgery at an appropriate time.
As the clear identification about the number and characteristics of ingested magnets via radiographic examination or patient history appears to be difficult in pediatric patients, close inpatient observation would be required in any case of undetermined metallic FB ingestion. Patients who are confirmed to have ingested multiple magnets should be regarded as conditional surgical patients, although their clinical conditions are stable.
尽管异物通常会自然且顺利地通过消化道，但其中一部分异物可能会滞留，最终导致严重损伤。特别是，摄入磁性物质可能会因通过肠壁的近距离吸引而导致严重的发病情况。
我们最近治疗了三名摄入多种磁性异物的儿科患者。这些患者均未表现出任何提示急腹症的临床症状或体征。此外，由于病史采集和影像学检查的局限性，很难确定明确的诊断和治疗方案。入院后，这些患者因以下原因接受了手术：（1）摄入的异物未能自然排出；（2）住院期间突然出现腹痛和呕吐；（3）在胃十二指肠镜检查中偶然发现胃穿孔。随后，所有患者均无并发症出院；然而，如果没有在适当的时候进行手术，他们的病情可能会致命。
由于通过影像学检查或患者病史明确摄入磁铁的数量和特征在儿科患者中似乎很困难，因此在任何不明金属异物摄入的情况下都需要密切住院观察。尽管临床状况稳定，但被证实摄入多个磁铁的患者应被视为有条件的手术患者。
