SLIDE 4 12/11/2012 4
Initial Presentation
Obtain History
- Known magnet ingestion
- Unexplained GI symptoms with rare earth magnets in the child’s environment
Obtain an abdominal x-ray. If magnets are present on flat plate of abdomen, obtain lateral x-ray of abdomen Determine single versus multiple magnet ingestion
Within the stomach, or esophagus
Single Magnet
Beyond the stomach , p g
Option 1: Consult pediatric gastroenterologist if available.
- Consider removal especially if patient is at
increase risk for further ingestion. Option2: Follow with serial x‐rays as outpatient and educate parents:
- Remove any magnetic objects nearby
- Avoid clothes with metallic buttons and belts
with buckles
- Ensure no other metal objects or magnets are
in the child environment for accidental ingestion
y
Consult pediatric gastroenterologist if available. Consider removal, if accessible Follow with serial x‐rays as outpatient Educate parents :
- Remove any magnetic objects nearby
- Avoid clothes with metallic buttons and belts
with buckles
- Ensure no other metal objects or magnets are
in the child environment for accidental ingestion Confirm passage with serial x‐rays
Multiple Magnets
All within the stomach or esophagus
If pediatric gastroenterologist if available, notify for removal and less than 12 hours since ingestion If no Pediatric Gastroenterologist is available, transfer to center where pediatric endoscopy is available If ingestion is greater than 12 hours prior to the time of procedure to remove magnets and consult surgery prior to endoscopic removal
Beyond the stomach
Consult pediatric gastroenterologist and pediatric surgery, if available If pediatric gastroenterologist and pediatric surgeon are not available, send to ref. center Management depends whether symptomatic or asymptomatic
Symptomatic
Refer to Pediatric surgery for removal
Asymptomatic
May remove by enteroscopy or colonoscopy if available and no signs of obstruction or perforation on x‐ray Consult pediatric surgery prior to endoscopic removal prior to endoscopic removal
Successful removal
Discharge home with appropriate follow‐up and education
Unsuccessful removal
Refer to pediatric surgery for removal Consult pediatric surgery prior to endoscopic removal May follow serial x‐rays for progression if no signs of bowel obstruction, partial bowel obstruction or perforation on x‐ray. Note: symptoms may be subtle
Successful removal
Discharge home after hospital
- bservation to ensure tolerance of
feeds with appropriate follow‐up and education
No Endoscopic Removal
Refer to Pediatric surgery May do serial x‐rays in ER to check for progression by checking films 4 to 6 hours apart No progression of magnets on serial x‐rays
Admit to hospital (may use PEG 3350 solution or other laxative prep solution to aid in passage and to help prep for colonoscopy) Continue serial x‐ray every 8 to 12 hours. If no movement in 24 hours or if patient becomes symptomatic , proceed with surgical or endoscopic removal
Progression of magnets on serial x‐rays
Educated parents on precautions and discharge with close follow‐up Confirm passage with serial x‐rays If at any time magnets do not progress or patient becomes symptomatic, admit
Battery ingestion
Battery ingestion major outcomes
.
Litovitz et al. Emerging battery-ingestion hazard: clinical implications. Pediatrics. Jun 2010;125(6):1168-77.
- Esophageal damage can occur
in a relatively short period of time- 2-3 hours when a disk battery is lodged in the esophagus
Batteries
Courtesy of Adele Evans M.D., Assistant Professor of Otolaryngology, Wake Forest University School of Medicine, Brenner Children's Hospital, Winston-Salem, NC
