Presentation
The child ingested magnetic balls. Asymptomatic at presentation.
Patient Data
Initial X-rays confirm foreign body ingestion, specifically 8 magnetic balls. They are arranged in a rosette pattern and appear dependent in the distal stomach.
There is incidental fecal loading. The abdominal X-rays are otherwise unremarkable.
The magnetic balls have remained in a rosette pattern and are now identified in the terminal ileum. There is no free intraperitoneal air, no bowel obstruction, and persistent fecal loading as per the initial X-rays.
At 32 hours post initial X-ray the magnetic balls remain in the terminal ileum. There are no delayed perforations or bowel obstruction. The X-rays are otherwise normal.
The child underwent a laparotomy and the magnetic balls were surgically removed.
The portable post-operative X-ray demonstrates free intraperitoneal air, a normal immediate postoperative finding. Uncertain nature of gauze overlying the patient's right hip.
Case Discussion
This is a companion case to a previous case of ingested magnetic balls causing small bowel perforation (rID 96061).
This child presented shortly after the companion patient ( 2 weeks later) to the emergency department after hours on a Saturday morning (01H30)
Knowing the potential complications of pressure erosion, perforations, and fistulous tracts caused by magnetic ball ingestion, this child was recalled to the emergency department for reassessment after the abdominal series (done after hours), was formally reported. The intention was to perform an urgent gastroscopy and attempt removal of the ingested magnetic balls and prevent downstream complications thereof. This window period was missed as the balls had already impacted the terminal ileum at a 12-hour duration. At this point, conservative management was considered.
At 32 hour duration, the magnetic balls remained impacted and the child started developing some abdominal complaints. An urgent laparotomy was performed and the magnetic balls were removed surgically.
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