Xin Yue, Jia Li Qun, Dong Ya Wei, Wang Yu, Hu Yan Xiu, Wang Xiao Man
Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Front Pediatr. 2023 Jan 13;10:988596. doi: 10.3389/fped.2022.988596. eCollection 2022.
The incidence of magnet ingestion by children has recently increased in China. Magnet ingestion is associated with an extremely high risk of gastrointestinal damage because loops of bowel can become trapped and squeezed between multiple magnets in different locations. However, the lack of imaging sensitivity makes clinical decision-making difficult.
This study was conducted to investigate the performance of ultrasound in diagnosing gastrointestinal magnet ingestion in children.
From April 2017 to February 2021, all children with a history of magnet ingestion or a diagnosis of gastrointestinal magnet as shown by x-ray or ultrasound in our hospital were included as study candidates. Patients who were lost to follow-up or had known malformations of the gastrointestinal tract were excluded. Eligible patients were those with surgical or endoscopic confirmation of gastrointestinal magnet, those who passed the magnet out of the alimentary tract without assistance, and those with confirmed absence of the magnet on abdominal x-ray examination after 1 month of conservative treatment. All eligible patients' ultrasound and x-ray examination data were evaluated. The sensitivity, specificity, and area under the curve (AUC) of ultrasound was calculated for diagnosing magnet ingestion, locating the magnet (stomach, small intestine, or colon), and confirming the phenomenon of wall entrapment.
Of 112 patients, 107 had a magnetic foreign body and 5 did not. Magnets were correctly detected by ultrasound in 97 patients, with an observed sensitivity of 90.65% and specificity of 100%. Satisfactory sensitivity was obtained for ultrasound localization of gastric magnets (96.30%) and small intestinal magnets (100.00%), but sensitivity for ultrasound localization of colonic magnets was relatively poor (73.33%). The discrimination of wall entrapment by ultrasound was good (AUC = 0.93), with an observed sensitivity and specificity of 92.00% and 93.62%, respectively.
Ultrasound can be used to locate gastrointestinal magnets (in the stomach, small intestine, or colon) with good clinical efficacy in identifying wall entrapment.
近年来，中国儿童吞食磁铁的发生率有所上升。吞食磁铁与极高的胃肠道损伤风险相关，因为肠袢可能会被困在不同位置的多个磁铁之间并受到挤压。然而，成像敏感性不足使得临床决策变得困难。
本研究旨在探讨超声在诊断儿童胃肠道磁铁吞食中的表现。
2017年4月至2021年2月，将我院所有有吞食磁铁病史或经X线或超声诊断为胃肠道磁铁的儿童纳入研究对象。排除失访或已知有胃肠道畸形的患者。符合条件的患者包括经手术或内镜证实有胃肠道磁铁的患者、无需协助即可将磁铁排出消化道的患者以及经1个月保守治疗后腹部X线检查证实无磁铁的患者。对所有符合条件的患者的超声和X线检查数据进行评估。计算超声诊断磁铁吞食、定位磁铁（胃、小肠或结肠）以及确认肠壁嵌顿现象的敏感性、特异性和曲线下面积（AUC）。
112例患者中，107例有磁性异物，5例没有。超声正确检测出97例患者体内的磁铁，观察到的敏感性为90.65%，特异性为100%。超声对胃内磁铁（96.30%）和小肠内磁铁（100.00%）的定位敏感性良好，但对结肠内磁铁的超声定位敏感性相对较差（73.33%）。超声对肠壁嵌顿的鉴别效果良好（AUC = 0.93），观察到的敏感性和特异性分别为92.00%和93.62%。
超声可用于定位胃肠道磁铁（在胃、小肠或结肠内），在识别肠壁嵌顿方面具有良好的临床疗效。
