Ingestion of Magnets in Children
High‑powered (rare‑earth) magnets are a paediatric emergency. Single magnets often pass without harm, but two or more magnets - or a magnet plus another metallic object - can attract across different bowel loops, producing pressure necrosis, perforation, fistulae, obstruction and sepsis.
Management must be timely, use dual‑view radiographs, and have a low threshold for paediatric surgical involvement (RCEM Best Practice).
High‑risk features requiring immediate paediatric surgical review
- Ingestion of multiple magnets or a magnet plus another metallic object (assume rare‑earth magnets if uncertain).
- Any acute abdominal signs: severe or worsening abdominal pain, peritonism/tenderness, persistent vomiting, fever, haematemesis or rectal bleeding, systemic sepsis.
Pathophysiology
- Magnets in different bowel loops can attract through the bowel wall, causing sustained pressure that leads to mucosal ischaemia, ulceration, perforation, fistula formation, strictures and haemorrhage.
- Symptomatic presentations carry a high rate of serious injury (perforation reported in ~50-75% of symptomatic cases).
Clinical presentation
- History: obtain a witnessed history if possible; ask about the type of product (toy sets, craft kits, gaming accessories), number of items and time of ingestion. If uncertain, manage as multiple.
- Examination: many children are initially asymptomatic. Look for abdominal pain, distension, peritoneal signs, vomiting, fever, dehydration and systemic features.