We report two recent cases of multiple magnet ingestion in children. The children, aged 18 months and 20 months, presented with vomiting, reduced oral intake and irritability and were initially thought to have viral gastroenteritis. On presentation, the children's physical examinations were only remarkable for signs of dehydration. Neither child had abdominal radiographs at admission due to a lack of clinical signs. With persistent vomiting on day 2 of admission, now bile-stained, and abdominal distension, abdominal radiographs were performed. Plain abdominal X-rays revealed the presence of multiple radio-dense objects intra-abdominally with associated small bowel obstruction (see Fig. 1).
Each of the children underwent emergency laparotomy and required resection of significant portions of small bowel due to the presence of multiple perforations. The individual magnets (five in one patient, seven in the other), in separate parts of the small intestine, had clumped together, thereby trapping intestinal wall between them. The trapped bowel wall between the magnets had become necrotic and had perforated (Fig. 2). Neither child had peritonitis as the perforations were localised by the magnets. Both children had unremarkable postoperative recoveries. On subsequent questioning, both sets of parents recalled recent events where magnet ingestion may have occurred.
The accidental ingestion of magnets by children is becoming increasingly common due to the rise in popularity of toys and novelty products containing small magnets. Unfortunately, the symptoms of magnet ingestion are vague,[2, 3] and obtaining a history can be difficult, as many caregivers may be unaware that the ingestion has occurred. Most solitary magnets will pass through the gastrointestinal tract without complication; however, the ingestion of multiple magnets is dangerous, as magnets in adjacent bowel loops attract to one another, potentially leading to bowel perforation, obstruction, volvulus or fistula formation. Interestingly, the localisation of the bowel trauma between the magnets can prevent overt peritonitis, thereby delaying investigations, diagnosis and surgery.
Bans on the sale of toys containing small magnets have been instituted worldwide since 2011, including in Australia. However, our first patient's family obtained the toy from overseas, and the second case occurred after the ban was instituted in 2012. This highlights the importance of continued awareness of this potentially devastating condition among both clinicians and parents. Additionally, tighter, universal regulation upon thesale of novelty items and toys containing multiple magnets may be required to prevent further near-fatal attractions.