Chavan Radhika, Bachkaniwala Vatsal, Tadkalkar Varun, Gandhi Chaiti, Rajput Sanjay
Ansh Clinic, Ahmedabad, Gujarat, India.
VideoGIE. 2022 May 25;7(8):302-307. doi: 10.1016/j.vgie.2022.03.008. eCollection 2022 Aug.
Magnet ingestion has recently increased among children. Multiple magnets can lead to serious adverse events owing to pressure necrosis of trapped bowel wall; therefore, urgent removal of the magnet is recommended. However, awareness of magnet ingestion and adverse events associated with it are lacking among the general population and some healthcare professionals. Herein, we demonstrate the adverse events associated with prolonged retention of ingested magnets and endoscopic management of ingested magnets in children.
We present a case series of 3 patients with magnet ingestion. Foreign body ingestion was confirmed on fluoroscopy. After fluoroscopy, all children underwent EGD under propofol sedation in a left lateral position. A Roth net was used to remove magnets.
Three patients (median age 5 years), each with ingestion of 2 magnets of different shapes and sizes and with variable periods of ingestion, underwent EGD. In 2 patients, both magnets were Successfully removed. In 1 patient, 1 magnet could not be removed because it became dislodged deep in the jejunum. All 3 patients had developed magnet-related fistula (gastroduodenal: 1 patient; duodenojejunal: 2 patients). Patients with duodenojejunal fistula were managed conservatively. There was mild self-limited bleeding during magnet removal in 1 patient. There were no major adverse events related to endoscopic removal.
Endoscopic removal of magnets is feasible and safe in children. Few patients with fistulas can be managed conservatively. There is an unmet need to increase societal awareness of magnet ingestions and adverse events associated with it.
儿童吞食磁铁的情况近来有所增加。多个磁铁可能因被困肠壁的压迫性坏死而导致严重不良事件；因此，建议紧急取出磁铁。然而，普通人群和一些医护人员对磁铁吞食及其相关不良事件缺乏认识。在此，我们展示了吞食磁铁长期留存相关的不良事件以及儿童吞食磁铁的内镜处理方法。
我们呈现了3例磁铁吞食患儿的病例系列。通过荧光透视确认有异物吞食。荧光透视后，所有儿童在丙泊酚镇静下左侧卧位接受上消化道内镜检查（EGD）。使用罗思网取出磁铁。
3例患者（中位年龄5岁），每人吞食了2个不同形状和大小的磁铁，吞食时间各不相同，均接受了上消化道内镜检查。2例患者的磁铁均成功取出。1例患者有1个磁铁因移位至空肠深处而未能取出。所有3例患者均出现了与磁铁相关的瘘管（胃十二指肠瘘：1例患者；十二指肠空肠瘘：2例患者）。十二指肠空肠瘘患者采取保守治疗。1例患者在取出磁铁过程中出现轻度自限性出血。未发生与内镜取出相关的重大不良事件。
内镜下取出儿童吞食的磁铁是可行且安全的。少数有瘘管的患者可采取保守治疗。提高社会对磁铁吞食及其相关不良事件的认识这一需求尚未得到满足。
