Taher Heba, Azzam Ahmed, Khowailed Omneya, Elseoudi Mohamed, Shaban Muayad, Eltagy Gamal
Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
Pediatric Surgery Department, Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
Int J Surg Case Rep. 2019;58:50-53. doi: 10.1016/j.ijscr.2019.03.043. Epub 2019 Apr 9.
Foreign body ingestion cases are very common in children. They usually present with obvious symptoms allowing proper diagnosis and management; however, magnet ingestion can be asymptomatic. This disorder is considered uncommon as well as challenging to diagnose before complications of intestinal obstruction or peritonitis occur due to entrapment of intestinal walls in the magnetic field.
An asymptomatic four-year-old male child was admitted to our centre after passing two bullet-shaped magnets in stool that were noticed by his mother. The child was asymptomatic. An abdominal X-ray revealed five bullet-shaped magnets in the lower abdomen. Laboratory investigations were normal except for a mild leukocytosis. Surgery was performed with excision of seven entero-enteric fistulae and two intestinal anastomoses.
Between 2003 and 2006, the Centers for Disease Control and Prevention reported 20 complicated cases of magnet ingestion in children aged 10 months to 11 years among whom 75% had bowel perforations, and 20% suffered from generalized peritonitis. Half that number of patients required emergency laparotomy. As a result, the Consumer Product Safety Commission (CPSC) issued the first warning announcing the hazards of high-powered magnets used in children's toys, which had been increasing exponentially. It is clear that the diagnosis of magnet ingestion is made commonly due to complications, such as peritonitis or death. However, the patient in this case was completely asymptomatic and had no complications.
A high index of suspicion regarding complications is recommended in asymptomatic cases of suspected magnet ingestion. Avoid delaying intervention once a diagnosis has been made.
异物吞食在儿童中非常常见。它们通常会出现明显症状，便于进行正确诊断和处理；然而，吞食磁铁可能没有症状。这种疾病被认为不常见，并且在因肠壁被磁场夹住而导致肠梗阻或腹膜炎并发症发生之前很难诊断。
一名无症状的4岁男童在其母亲发现他随粪便排出两块子弹形磁铁后被收治到我们中心。该儿童没有症状。腹部X线检查显示下腹部有五块子弹形磁铁。实验室检查除轻度白细胞增多外均正常。手术切除了七个肠-肠瘘和两个肠吻合口。
2003年至2006年期间，疾病控制与预防中心报告了20例10个月至11岁儿童吞食磁铁的复杂病例，其中75%有肠穿孔，20%患有弥漫性腹膜炎。半数患者需要紧急剖腹手术。因此，消费品安全委员会（CPSC）发布了首个警告，宣布儿童玩具中使用的高功率磁铁的危害，此类危害一直在呈指数级增长。显然，吞食磁铁的诊断通常是由于并发症，如腹膜炎或死亡。然而，该病例中的患者完全没有症状且没有并发症。
对于疑似吞食磁铁的无症状病例，建议高度怀疑有并发症。一旦确诊，避免延迟干预。
