Kelaidi Natalia, Dimopoulou Konstantina, Dimopoulou Dimitra, Krikri Aggeliki, Siouli Christina, Berikopoulou Maria M, Zavras Nikolaos, Dimopoulou Anastasia
Department of Pediatric Surgery, Children's General Hospital "Aghia Sophia", 115 27 Athens, Greece.
Department of Gastroenterology, Korgialenio-Benakio Red Cross Hospital, 115 26 Athens, Greece.
J Clin Med. 2025 Sep 3;14(17):6235. doi: 10.3390/jcm14176235.
Entero-enteric fistula (EEF) formation following multiple magnet ingestion is a rare but severe complication among pediatric patients. The widespread availability of neodymium magnets in toys has increased incidence of ingestion and subsequent gastrointestinal injuries. This systematic review aims to summarize the clinical features, diagnostics, management and outcomes of pediatric EEF cases related to magnet ingestion and report our institution's experience with four such cases. A systematic review was conducted using PubMed/Medline (January 1995-February 2025), focusing on EEF after ingestion of ≥2 magnets in patients ≤18 years old. Studies reporting original EEF cases were included. Data extraction included demographics, clinical presentation, diagnostic imaging, intervention type, fistula number/location, hospital stay, complications and outcomes. Four institutional cases were also analyzed. Sixty-nine studies encompassing 130 pediatric patients were included. Median age was 3.3 years; 58% were male. The most common symptoms were abdominal pain (43%) and vomiting (29%). Abdominal X-ray identified magnets in all cases. Surgical intervention was required in 95.5%, while 5.5% were treated endoscopically. Ileal and jejunal fistulas were most common. Postoperative complications occurred in 19%, including bowel obstruction, infection and one death. Our four cases, aged 2 months to 5 years, each required surgery, with one patient readmitted for obstruction managed conservatively. : Despite the case heterogeneity of this review, EEF is a potentially life-threatening complication of multiple magnet ingestion in children. Prompt diagnosis with abdominal X-ray and timely surgical management are essential. Increased clinical suspicion and public awareness are crucial for prevention and early intervention.
多枚磁铁摄入后发生肠-肠瘘（EEF）是儿科患者中一种罕见但严重的并发症。玩具中广泛使用的钕磁铁增加了摄入及随后胃肠道损伤的发生率。本系统评价旨在总结与磁铁摄入相关的儿科EEF病例的临床特征、诊断、治疗及结局，并报告我们机构处理的4例此类病例的经验。使用PubMed/Medline（1995年1月至2025年2月）进行了系统评价，重点关注18岁及以下患者摄入≥2枚磁铁后发生的EEF。纳入报告原发性EEF病例的研究。数据提取包括人口统计学、临床表现、诊断性影像学检查、干预类型、瘘管数量/位置、住院时间、并发症及结局。还分析了4例机构内病例。纳入了69项研究，共130例儿科患者。中位年龄为3.3岁；58%为男性。最常见的症状是腹痛（43%）和呕吐（29%）。所有病例腹部X线检查均发现了磁铁。95.5%的患者需要手术干预，5.5%的患者接受了内镜治疗。回肠和空肠瘘最为常见。术后并发症发生率为19%，包括肠梗阻、感染，1例死亡。我们的4例患者年龄在2个月至5岁之间，均需要手术治疗，1例患者因肠梗阻再次入院，接受了保守治疗。尽管本评价中的病例存在异质性，但EEF是儿童多枚磁铁摄入潜在的危及生命的并发症。通过腹部X线进行快速诊断并及时进行手术治疗至关重要。提高临床怀疑意识和公众认知度对预防和早期干预至关重要。
