P1.037: Developing a Management Protocol for Magnet Ingestion in Pediatric Patients

Background: The availability of ingestible size products that contain magnetic components has resulted in a continued increase of magnet ingestion in children. The ingestion of multiple magnets may lead to significant complications requiring surgical intervention. Prior studies support conservative management of the ingestion of multiple magnets that have progressed beyond the stomach in asymptomatic children. However, clear guidelines on duration of conservative management are lacking. We aimed to review our clinical experience to develop a protocol for the treatment of children who ingested multiple magnets.

Methods: A retrospective chart review was performed including children seen at a free-standing children’s hospital who ingested a foreign body concerning for magnet(s) from January 1st, 2000, to December 31st, 2024. We collected information on patient demographics, symptoms, radiologic studies, and interventions performed.

Results: We identified 143 children who ingested one or more magnets over the 24-year period. Seventy-four percent (n=106) of all ingestions were unwitnessed. Fifty-seven percent (n=81) of ingestions involved multiple magnets. Children who ingested multiple magnets were older (7 years, [IQR 3,10], p-value 0.014*) than those who ingested a single magnet. The vast majority of those children ingesting single magnets (94%, n=58) were managed conservatively with only 10% (n=6) requiring an intervention due to worsening symptoms. The most common intervention in this group was endoscopy. Of the 81 children who ingested multiple magnets, 53% (n=43) were managed conservatively, with over half (n=25) requiring no intervention. In those patients that failed conservative management, abdominal pain, nausea and vomiting were the most common presenting symptoms. An additional reason for failure of conservative management leading to intervention was lack of magnet progression on imaging. The median duration between admission and endoscopic/surgical intervention after failed conservative management was 19.5 hours [IQR 16.2, 37.0]. Of the children (n=56) who required an intervention after ingesting multiple magnets, 8 underwent endoscopic intervention and 48 underwent surgical exploration. Enteroenteric fistula, bowel perforation and/or bowel obstruction were the most common operative findings. We used these findings to develop an algorithm for treatment of magnet ingestions (Figure 1).

Conclusion: Children displaying worsening symptoms and/or failure of the objects to progress within 24 hours should undergo prompt intervention. In response to our study of this data, we developed an algorithm for the management of pediatric magnet ingestions.