Doctors at a hospital in Sharjah extracted 17 magnets that were accidentally swallowed by a two-year-old boy. Thirteen magnets were removed by endoscopy—a tube was inserted into the toddler’s mouth that travelled down his food pipe—while the remaining four were surgically removed.
The incident occurred last week when baby AH was brought to Burjeel Specialty Hospital–Sharjah with complaints of nausea and inability to eat for three days.
The parents were unaware of the time of ingestion, but they said at least 72 hours must have passed after the accidental incident. According to the medical report, the patient also did not pass stool for 48 hours.
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Dr Mehreen Zaman, specialist gastroenterologist at Burjeel Specialty Hospital–Sharjah, who led the surgery, said, “Endoscopy was done under general anaesthesia to remove the magnets. It was a complicated procedure that lasted for two hours. The magnetic power was so strong – holding all the pieces together – and it was difficult to separate them. But all magnets (measuring almost an inch each) were removed one by one, and the toddler has been discharged and is now fine.
Primary investigation and findings
Baby AH registered sluggish bowel sounds on examination. Bowel sounds are indication of food passing through the digestive system. When these sounds are absent or reduced, it may mean the intestines are not working properly and can cause serious problems. The toddler was irritable and anxious.
An abdominal X-ray was conducted and it showed presence of magnets stacked one upon the other in the stomach. Thankfully, the laboratory investigations (urine and blood tests) were normal.
Treatment plan
On Wednesday, Dr Zaman told Khaleej Times that a gastroscopy was performed to retrieve the magnets under general anaesthesia. Gastroscopy is a non-surgical procedure for examining the stomach. A flexible, thin tube called a gastroscope was used to look inside the stomach and duodenum (the first part of the intestine). At the end of the gastroscope, a small camera sent images to the monitoring screen.
“During gastroscopy, magnets were seen in the body and antrum (lowermost part of the stomach). Some of them were impacted, suggesting the possibility of magnets being there for 72 to 96 hours at least,” noted Dr Zaman.
The magnets were also seen impacting the pylorus (the part of the stomach that connects to the duodenum, the first part of the small intestine). The pylorus is a valve that opens and closes during digestion. This allows partly digested food and other stomach contents to pass from the stomach to the small intestine.
Retrieving one by one
The toddler was put under general anaesthesia, and Dr Zaman said magnets were retrieved via rat-tooth tissue forceps and were snared one by one over two hours.
After 13 magnets were retrieved via endoscopy, fluoroscopic images were taken to locate the remaining four pieces. The images transmitted showed the last four magnets were stacked together and had passed on to the distal intestine (end of the small intestine).
“The suspicion was that they might be impacted at the ileocaecal junction (this marks the transition from the small bowel to the large bowel),” said Dr Zaman, adding: “Colonoscopy was done immediately to see possibility of retrieval through the ileocaecal junction but the caecum (a pouch connected to the junction of the small and large intestines) was full of hard stools and no access to ileum was possible.”
Surgical incision
The general surgery team was consulted for opinion on surgical intervention to retrieve the remaining four magnets. Dr. Mohamed El Sayed Eraki Ibrahium, medical director and consultant general, Laparoscopic Surgery & Oncosurgery), and Dr. Saima Asrar, specialist general and Laparoscopic surgeon, were both of the opinion to do laparotomy, a surgical cut or incision into the toddler’s abdominal cavity.
“This procedure was necessary to retrieve the last four magnets as they were stacked together and would make it difficult to pass through the narrow ileocaecal junction, considering patient already had started developing symptoms of partial intestinal obstruction,” noted Dr Zaman.
Lapratomy was done immediately and the remaining four magnets removed.
Challenging procedure
Dr Zaman congratulated the entire medical team. She said: “It was very difficult to remove magnets endoscopically because of sheer magnetic force of the pieces stacked together, making it difficult to separate and overcome magnetic forces.”
“When we did somehow manage to separate a piece, it slipped from the forcep and it went back to get attached to the remaining stack. Also some pieces were impacted in the stomach wall because of the amount of time they had been in the stomach causing localised superficial necrosis of wall,”
“The magnetic power was so strong holding all pieces together, and it was difficult to separate them. But all pieces were removed and the baby is now fine,” she assured.