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CASE FILES – Magnet Ingestion

Child playing with toy magnets

Toxicology Case Files from the Utah Poison Control Center

Teaching Points
  • Ingestion of multiple magnets may result in serious complications as they may attract between separate loops of bowel
  • Immediate x-ray with at least 2 views is indicated for suspected magnet ingestion
  • Multiple magnets in the stomach should be removed by endoscopy
  • Post-pyloric magnets require frequent reevaluation for progression and potential complications
Multiple Magnet Ingestion

A 5-year-old male was suspected to have swallowed magnets from a toy clock. Some were found missing from the clock the night before, and the patient was seen putting one in his mouth the next morning. Given potential for multiple magnet ingestion, the family was referred to the ED.

An abdominal x-ray showed 3-4 magnets in separate locations. Pediatric surgery was consulted, who recommended a bowel cleanout and follow-up x-ray and clinic visit the next morning.

Though the patient had some abdominal pain and diarrhea prior to presentation, he was asymptomatic in the ED and at the clinic visit the next morning.

On follow-up x-ray, the magnets had come together, suggesting the possibility the magnets had come in opposition with bowel wall trapped between. Pediatric surgery decided to proceed with operative removal though the patient appeared asymptomatic.

The next day, a diagnostic laparoscopy was performed. Four magnets were removed via EGD from the stomach, and a small fistula was seen. Presumably, the magnets that had been distal to the pylorus on previous x-rays had reconnected with the magnets in the stomach and caused a perforation. The patient tolerated the procedure well and was discharged home the following day with outpatient follow-up.

Management of Magnet Ingestion

Ingestion of a single magnet without any other metallic foreign bodies is generally well-tolerated. However, ingestion of multiple magnets may be dangerous as they may come together across separate loops of bowel, injuring the interposed tissue. Though rare-earth magnets such as neodymium magnets in toys such as “Buckyballs” are classically implicated, any type of magnets may cause significant injury, as in this present case.

Any child suspected of ingesting one or more magnets should have immediate imaging in two planes to identify the number, type, and position of the foreign bodies. Single magnets may be managed conservatively though the possibility of multiple magnets appearing as a single magnet on x-ray must be considered.

Magnets in the stomach should be removed immediately by endoscopy. Post-pyloric magnets are more challenging. An attempt at promoting passage of the magnets with a bowel prep should be made while monitoring the patient for symptoms of perforation or obstruction. Serial x-rays should be done, generally as an inpatient, to monitor progress of the magnets.

If the magnets come together or fail to progress, the possibility of trapped bowel wall must be considered. Depending on location of the magnets, EGD, colonoscopy, or laparoscopy may be used to retrieve the magnets.

Professional societies have published management guidelines for ingestion of magnets (see below).

  1. Hussain SZ, Bousvaros A, Gilger M, Mamula P, Gupta S, Kramer R, Noel RA. Management of ingested magnets in children. J Pediatr Gastroenterol Nutr. 2012 Sep;55(3):239-42. doi: 10.1097/MPG.0b013e3182687be0. PMID: 22785419.

Author: Michael Moss, MD, FAACT, Medical Director, Utah Poison Control Center