Pediatric Gastroenterology, Hepatology, and Nutrition, University of Nebraska Medical Center, Omaha, NE, USA.
Transplantation Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Pediatr Transplant. 2021 May;25(3):e13915. doi: 10.1111/petr.13915. Epub 2020 Nov 20.
Ingestion of rare-earth magnet beads in children has been a public health concern. The potential risk of swallowing multiple magnets is related to magnet attraction to each other, resulting in serious gastrointestinal complications, such as entero-enteric fistula formation, peritonitis, bowel ischemia or necrosis, bowel perforation, and potentially death. We describe the clinical outcome of a 10-year-old child with a liver-small bowel-pancreas transplant who swallowed 26 rare-earth magnetic beads. The patient presented with fever and abdominal pain. Due to difficulty locating the magnets and post-surgical anatomy changes, only 25 magnets were removed endoscopically. After the procedure, she continued to have abdominal distention and fever, leading to further investigation and subsequently an exploratory laparotomy, which confirmed a walled-off perforation. She was treated conservatively with bowel rest and antibiotics, without the need for small bowel graft resection. She recovered well and was eventually discharged on her home enteral feeding regimen. This case emphasizes the importance of taking a good history and having a high index of suspicion to diagnose this dangerous clinical condition, especially in children with an associated predisposing condition for foreign body ingestion, such as developmental delay. Early diagnosis of multiple magnet bead ingestion and prompt detection of its complications in pediatric intestinal transplant recipients could help initiate appropriate intervention and prevent intestinal graft loss.
儿童吞食稀土磁铁珠已引起公众健康关注。吞食多个磁铁的潜在风险与磁铁之间的吸引力有关，可能导致严重的胃肠道并发症，如肠肠瘘形成、腹膜炎、肠缺血或坏死、肠穿孔，并可能导致死亡。我们描述了一名 10 岁肝小肠胰腺移植患儿吞食 26 颗稀土磁铁珠的临床转归。患儿表现为发热和腹痛。由于难以定位磁铁和术后解剖结构改变，仅通过内镜取出 25 颗磁铁。手术后，她仍有腹胀和发热，进一步检查后行剖腹探查术，证实为包裹性穿孔。她接受了保守治疗，包括肠道休息和抗生素治疗，无需小肠移植物切除。她恢复良好，最终在接受家庭肠内喂养方案后出院。该病例强调了获取详细病史和保持高度怀疑以诊断这种危险临床情况的重要性，尤其是对于存在吞食异物相关易感因素的儿童，如发育迟缓。对于儿童肠移植受者，早期诊断多次磁铁珠吞食并及时发现其并发症有助于及时采取适当干预措施，防止肠移植物丢失。
