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Ingested Multiple Magnets


KEY FACTS

Terminology

  • Ingestion of multiple magnets or single magnet + additional metallic foreign bodies

    • Potential for significant bowel complications

  • Rare-earth magnets 5-10x stronger than traditional magnets

Imaging

  • Metallic density foreign bodies; shapes variable

  • Magnets attract through bowel walls

    • Multiple “stacked” magnets may simulate single rectangular or cylindrical foreign body

  • Entrapment of interposed bowel wall suggested with

    • Gap between otherwise closely apposed magnets or magnet & adjacent metallic foreign body

    • Failure of magnet to move on sequential radiographs

  • Abnormal bowel gas patterns from complications

    • Ulceration, perforation, fistulae, obstruction, volvulus

  • Foreign body ingestion radiographic series includes

    • Frontal views of neck through anus, ± lateral view of upper airway

    • Targeted lateral views if foreign body identified

Clinical Issues

  • Symptoms: None, abdominal pain/vomiting, choking

  • Management depends on number of magnets, location in GI tract, & symptoms

    • Single magnet: Remove vs. follow radiographic passage

    • Multiple magnets or magnet + metal in esophagus/stomach: Endoscopic or surgical removal

    • Multiple magnets or magnet + metal beyond stomach

      • –

        With symptoms &/or abnormal bowel gas pattern: Operative exploration with magnet removal

      • –

        Without symptoms or abnormal bowel gas pattern: Consider careful, frequent clinical & radiographic evaluation until passage vs. removal

Frontal upright abdominal radiograph of a 12-year-old autistic boy with abdominal pain & bilious emesis shows multiple rod-shaped metallic foreign bodies
, most of which appear linked. Small gaps
between the magnets may represent entrapped intervening bowel. Numerous small bowel perforations & fistulae were noted at surgery.

Frontal radiograph shows 2 clusters of magnets
that attracted additional ingested metallic foreign bodies
. Associated bowel perforations were present at surgery.

Frontal upright chest radiograph in an asymptomatic 2 year old suspected to have swallowed magnets shows a chain of magnets
projecting over the stomach. The magnets were removed endoscopically.

Frontal upright abdominal radiograph from an asymptomatic 13 year old who swallowed 6 magnets shows a stack of metallic foreign bodies
in the left abdomen. Jejunal & colonic perforations due to the magnets attracting across bowel walls were found at surgery.

TERMINOLOGY

Synonyms

  • Postgastric magnetopathy

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