Pediatr Gastroenterol Hepatol Nutr.  2018 Oct;21(4):336-340. 10.5223/pghn.2018.21.4.336.

Non-Surgical Management of Gastroduodenal Fistula Caused by Ingested Neodymium Magnets

• Phen C
• Wilsey A
• Swan E
• Falconer V
• Summers L
• Wilsey M

• KMID: 2421997
• DOI: http://doi.org/10.5223/pghn.2018.21.4.336

Abstract

Foreign body ingestions pose a significant health risk in children. Neodymium magnets are high-powered, rare-earth magnets that is a serious issue in the pediatric population due to their strong magnetic force and high rate of complications. When multiple magnets are ingested, there is potential for morbidity and mortality, including gastrointestinal fistula formation, obstruction, bleeding, perforation, and death. Many cases require surgical intervention for removal of the magnets and management of subsequent complications. However, we report a case of multiple magnet ingestion in a 19-month-old child complicated by gastroduodenal fistula that was successfully treated by endoscopic removal and supportive care avoiding the need for surgical intervention. At two-week follow-up, the child was asymptomatic and upper gastrointestinal series obtained six months later demonstrated resolution of the fistula.

Keyword

Gastric fistula; Intestinal fistula; Magnets; Neodymium; Endoscopy

MeSH Terms

Child
Eating
Endoscopy
Fistula*
Follow-Up Studies
Foreign Bodies
Gastric Fistula
Hemorrhage
Humans
Infant
Intestinal Fistula
Mortality
Neodymium*
Neodymium

Figure

• 

  Fig. 1 Upper gastrointestinal series shows a series of foreign bodies attached end-to-end and looping from the stomach through the duodenum.

• 

  Fig. 2 (A) Forceps could not separate the magnets due to the strong magnetic attraction and therefore a loop snare was inserted between the magnets. Attempts to pull the imbedded magnet away from the gastric wall using the loop snare (B, C) only led to the emergence of a distal yellow magnet from the small intestine (D) in to the gastric lumen. This raised the concern for intestinal perforation.

• 

  Fig. 3 (A, B) Several magnets are depicted as they emerge from the small intestine into the stomach. (C) A large round magnet is identified in the second portion of the duodenum. (D) Gastroduodenal fistula is identified in the body of the stomach following magnet removal.

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