Undisclosed Multiple Magnet Ingestion Simulating Appendicular Mass in a 5-Year-Old Girl—a Case Report and Review of Literature

Foreign body ingestion is common in children. The majority of ingested foreign bodies pass spontaneously through the gastrointestinal (GI) tract without difficulty, but serious complications can occur. Ingestion of magnetic foreign bodies poses a significant risk of complications due to proximate attraction through the intestinal wall leading to bowel perforation, fistula, and obstruction. A 5-year-old girl referred by GP with a history of right-sided abdominal pain woke her mother at midnight, complaining of right iliac fossa pain not relieved with paracetamol, associated with 2 episodes of vomiting and one episode of loose bowel motion. On examination, she was in mild pain, not distressed; her vital signs were stable. Abdominal examination revealed tender right iliac fossa with weak rebound and mild guarding with no rigidity. WBC was 16.9, with 12.68 neutrophils, with normal urea, creatinine, amylase, CRP, and liver function tests. The patient was admitted for observation, appendicitis, and gastroenteritis. She was kept Nil per mouth and started on intravenous fluid and analgesics for review in the morning. She was reviewed in the morning round by team; she was still in pain with tender right iliac fossa and guarding, booked for abdominal ultrasound, which showed a free fluid in the pelvis; appendix was not seen and there was a mass in the right iliac fossa. Patient was started on intravenous co-amoxiclav and consented for laparoscopic appendectomy ± proceed. Diagnostic laparoscopy revealed a normal appendix with free fluid in pelvis. The omentum was stuck to terminal ileum with two necrotic patches and a perforation in terminal ileum with a magnetic foreign body protruding from the perforation site. There was no peritoneal contamination; see Fig. 1. Laparotomy was performed via right lower transverse incision with resection and anastomosis of necrotic perforated bowel segment with removal of three magnetic foreign bodies from terminal ileum. Patient had smooth postoperative recovery. The ingestion of magnets or a magnet and another metallic part should be considered an impending surgical emergency as it is unlikely to pass spontaneously and complications are more likely. There are no reports where more than one magnet was passed spontaneously. Early intervention is indicated if the history, clinical findings, and imaging are suggestive of multiple magnetic ingestion to prevent serious life-threatening complications.