Treatment of cecal perforation with magnetic beads in a teenager: A case report

In recent years, the incidence of magnetic ingestion in children has been rapidly increasing in many countries of the world. It is especially dangerous to swallow multiple magnets because they can be attracted to each other and damage the walls of the stomach and intestines. Swallowing magnets is most common in children between the ages of 6 months and 4 years, and much less common in teenagers. Case description. A 13-year-old boy presented to an emergency department complaining of abdominal pain. Multiple vomiting was noted the day before the visit. The bowel movements were regular. The patient was admitted to the hospital with suspected acute appendicitis. Clinical examination and abdominal ultrasound ruled out this diagnosis. Due to the unclear cause of the abdominal pain, a plain abdominal X-ray was performed, which revealed multiple metallic dense bodies in the projection of the cecum. Further questioning revealed that the patient had swallowed several dozen magnetic spheres 2 weeks prior to the visit. Diagnostic laparoscopy was performed and revealed an infiltrate consisting of a portion of the ileum and greater omentum in close proximity to the head of the cecum. When dividing the infiltrate, the wall of the cecal head was found to perforate. The decision was made to convert the access. By transverse mini-laparotomy in the right iliac region, the abdomen was opened, the cecum was exposed with a defect through which part of the foreign bodies was removed. There were 18 magnetic beads. The remaining beads migrated into the colon. Intraoperative radiographs showed 
foreign bodies as a single conglomerate in the ascending colon projection. The intestinal defect was sutured and the omentum lesion was resected. The progress of the magnets was monitored by stool examination and radiography. A follow-up X-ray on day 3 showed that the beads remained in the projection of the hepatic angle of the colon. A colonoscopy was performed and 15 magnetic beads were removed. Recovery of the patient. Children of any age can swallow magnets. To clarify the diagnosis of abdominal pain syndrome of unknown etiology in children, it is necessary to ask parents and children about possible contact with magnets and perform plain abdominal radiography. The surgical treatment strategy using laparoscopy and intraluminal endoscopy depends on the location of the magnetic foreign bodies and the presence of intra-abdominal complications.