Department of Pediatric Surgery, İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, İstanbul-Türkiye.
Department of Radiology, İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 May;30(5):361-369. doi: 10.14744/tjtes.2024.50845.
Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.
儿童吞食磁铁可导致严重并发症，包括急性和慢性并发症。本病例报告讨论了一例因多次吞食磁铁导致的治疗方法，该病例导致空肠-结肠瘘、节段性肠扭转、肝脂肪变性和肾结石，这些并发症在晚期才被发现。此外，我们进行了文献回顾，以探讨磁铁吞食引起的肠瘘的特征。一名 6 岁女孩因间歇性腹痛、呕吐和腹泻持续两年而被收入儿科消化科。最初的鉴别诊断包括乳糜泻、囊性纤维化、炎症性肠病和结核病，但病因仍不明确。根据磁共振成像结果怀疑存在空肠-结肠瘘后，咨询了小儿外科团队。体格检查未发现急性腹痛的迹象，但有轻度腹胀。随后的上消化道系列和对比灌肠造影证实存在空肠-结肠瘘和节段性扭转。后来，家人报告说孩子在两年前吞食了一块磁铁，并且在一到两周内磁铁自行排出后停止了医疗随访。需要进行手术干预以纠正扭转和修复大的空肠-结肠瘘。为了识别相关研究，我们根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南详细搜索了关于磁铁吞食和胃肠道瘘的文献。我们共确定了 44 篇文章，其中包括 55 例症状未在急性期表现出且未观察到急性腹痛的病例。在 29 例中，吞食磁铁的时间未知。在 26 例已知吞食时间的病例中，从吞食到发现瘘管的平均时间为 22.8 天（范围：1-90 天）。47 例通过剖腹手术进行瘘管修复。
