Delayed presentation of rare‐earth magnets

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Paediatric foreign body ingestions frequently resolve spontaneously, however, the ingestion of magnets can result in serious sequelae. Rare-earth magnets, like Buckyballs, are 5–10 times stronger than everyday magnets and can attract through intestinal walls.1 Complications can include intestinal perforation, fistula, volvulus and even death.2 Prompt evaluation is necessary to avoid potentially fatal outcomes, with signs occurring as early as 8 h post-ingestion.1 Here we illustrate a case of delayed diagnosis 3 years after an 11-year-old female swallowed Buckyballs. She presented initially with constipation and abdominal pain for 1 week. Work-up at an outside facility identified a calcified teratoma on ultrasound that correlated with an x-ray (Fig. 1). She was instructed to see a gynaecologist but instead presented to our institution a week later with unresolved symptoms and vomiting. A CT scan showed foreign bodies clustered within the small bowel concerning for magnets (Fig. 1). Of note, it is unusual to require multiple imaging techniques to diagnose a foreign body. At this time the patient vigorously denied foreign body ingestion, seemed a reliable historian and had a long history of issues with constipation and vague abdominal pain. In addition, the patient's father admitted to discarding his set of Buckyballs at least 3 years ago. The patient then underwent a limited laparotomy. Multiple well-formed small bowel fistulae were noted containing a chain of magnetic balls with hair (Fig. 1). Since the magnets appeared corroded and fistulae very well formed a remote ingestion was evident. To remove the magnets a bowel resection with primary anastomosis was performed. In a study analysing data from the US Consumer Product Safety Commission on children with magnet related injuries, surgery was required in nearly 70% and bowel resection in 17% of cases. Despite a 2014 ban on magnetic toys from the Consumer Product Safety Commission due to findings such as these millions were sold previously and are likely still present in US homes.3 Similarly, the Commonwealth Assistant Treasurer in Australia issued a ban on these magnets in 2012.4 While treatment delays of 2 months and even a delay of six months were reported, there has not been documentation of more protracted cases.2 Our patient presented at least 3 years after magnet ingestion with obstructive symptoms that were initially misdiagnosed as a teratoma. Consequently, we aim to emphasise the potential for remote presentations of consuming multiple magnets, which may be years after the initial ingestion.

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