Volvulus and Intestinal Perforation Following Magnet Toy Ingestion

A 7-year-old boy transferred to our surgical service had been admitted 4 days earlier to a community hospital for abdominal pain after ingestion of multiple magnetic toys; initial abdominal radiograph revealed multiple magnetic toys (Fig. 1A) with no evidence of intestinal obstruction. After 4 days of inpatient observation, he developed abdominal distension, with increasing abdominal pain and emesis. Radiograph revealed dilated intestine with rotation of the object (Fig. 1B). He was transferred to our pediatric surgical service for emergency laparotomy. Small bowel volvulus associated with multiple intestinal and mesenteric perforations was found (Fig. 2A). Eleven magnetic toys and a 5-cent coin were removed (Fig. 2B), the volvulus was reduced, and the perforations were repaired. Postoperative course was unremarkable.FIGURE 1: Day 1 plain x-ray revealed the presence of multiple L-shaped magnetic toys (A). A toy's rotation of approximately 180 degrees was observed after 4 days (B).FIGURE 2: Multiple mesenteric perforations caused by magnetic attraction observed during surgical exploration (A). Magnetic toys and a 5-cent coin reconstruct in the original form after removal (B).Ingestion of magnetic toys is rare in children. Magnetic attraction force causes pressure bowel necrosis with perforation, fistula, or volvulus (1). The number, location, and the timing of magnet ingestion guide the roles of the pediatric gastroenterologists and surgeons in the management (2). Radiography is an indispensable component in these decisions (3). Close observation and early intervention, through endoscopy or surgical exploration, may help prevent more severe complications. Public education and prevention efforts are indispensable to decrease the incidence of ingestion of magnet toys (4).