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How we saved girl who swallowed tiny magnets — Limpopo doctors

Dave Chambers Cape Town bureau chief
Dr Elliot Motloung
Dr Elliot Motloung
Image: LinkedIn

A five-year-old from Limpopo who swallowed tiny magnetic beads ended up with multiple perforations in her bowel.

Doctors who operated on the girl at Mankweng Hospital in Polokwane said the strength of the rare earth magnets made them a menace, because they trapped tissue between them.

“Toys made of magnetic beads are hazardous and have the potential to cause lethal consequences in children,” said Dr Elliot Motloung, head of paediatric surgery at Mankweng and a senior lecturer at the University of Limpopo.

Writing in the Journal of Pediatric Surgery Case Reports, he added: “After ingestion, these magnets coalesce in different segments of the intestines, causing pressure necrosis which results in intestinal perforation and/or fistula formation along the gastrointestinal tract.”

Last week, a group of British doctors experts said magnets can cause serious injury when swallowed.

Magnets similar to these left a five-year-old Limpopo girl with several holes in her bowel after she swallowed them.
Magnets similar to these left a five-year-old Limpopo girl with several holes in her bowel after she swallowed them.
Image: takealot.com

In a letter published in the Archives of Disease in Childhood, paediatricians from some of the top hospitals in London said under-fours commonly swallow “foreign bodies” that do not cause any damage, but “magnets commonly found in household toys have the potential to cause serious injury”.

They said they had seen a fivefold increase in magnet ingestion in recent years and recommended “a strong public health campaign to increase awareness of the dangers of small, powerful magnets, especially those intended for toys, and to work with manufacturers in clearly warning purchasers of the dangers for children”.

Concern is also rising in the US, where magnetic bead toys went back on the market in 2016 after being banned for four years.

“These magnets can do a lot of damage, require surgery, or even cause death when swallowed. We are seeing more cases in our emergency room,” said Jonathan Kohler, medical director for paediatric trauma at UC Davis Children’s Hospital in Sacramento.

The magnets often come in bright colours and are used as stress-relief desk toys or building kits. Teenagers use them to mimic body piercings by placing two magnets on either side of the tongue, lips or cheeks.

“When swallowed, these magnets can attach to each other through the bowel, leading to fistulas, which are abnormal connections between two parts inside of the body, or they can create holes in the intestines,” said UC Davis paediatric gastroenterologist Sunpreet Kaur.

An x-ray showing the magnets in the Limpopo girl's intestine.
An x-ray showing the magnets in the Limpopo girl's intestine.
Image: Journal of Pediatric Surgery Case Reports

Motloung and his colleagues said the five-year-old who arrived at Mankweng Hospital had suffered five days of vomiting, nausea, fever, constipation and pain. An abdominal X-ray showed a foreign body that looked like a chain of beads.

Once her abdomen was opened, doctors found holes in her small bowel with magnetic beads protruding from loops in the bowel.

“The patient recovered well postoperatively with the resumption of normal bowel habits on day two, discharged on day four. A review done after three months showed a healthy growing child,” said Motloung.

He said subsequent experiments with magnetic beads like those removed from the girl's bowel showed that they attracted each other when separated by up to 3.5cm.

“The strength of magnetic attraction increases in the case of multiple magnetic beads as beads orient themselves in a manner that they do not repel one another,” he said.

A doctor removes the magnets from the Limpopo five-year-old's bowel.
A doctor removes the magnets from the Limpopo five-year-old's bowel.
Image: Journal of Pediatric Surgery Case Reports

“When magnetic beads are found in separate parts of the gastrointestinal tract, the tissues in between the magnets can be damaged by pressure exerted by the magnets, resulting in tissue necrosis and perforation.”

Motloung urged caregivers to be aware of the “detrimental effects of these toys in the hands of inquisitive kids” and said doctors should have a “high suspicion index in children who are suspected to have had ingested a toy”.

He added: “A plain [X-ray] of the chest and abdomen may help with locating these foreign bodies as the initial investigation at the emergency unit. Careful evaluation of the foreign body should be done because magnets may take any form that may mislead the emergency physicians.”

Motloung said written informed consent had been obtained for publication of the case report and accompanying images.

TimesLIVE

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