Magnet ingestion - Revision history

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2026-03-22T09:30:06Z

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	==Clinical Features==		==Clinical Features==
	*Many patients are ~~'''~~asymptomatic~~'''~~ in the early phase, leading to delayed presentation<ref name="Altokhais2021"/>		*Many patients are asymptomatic in the early phase, leading to delayed presentation<ref name="Altokhais2021"/>
	*Ingestion is frequently unwitnessed, especially in young children		*Ingestion is frequently unwitnessed, especially in young children
	*Symptoms are often nonspecific and may mimic [[Acute gastroenteritis\|acute gastroenteritis]]		*Symptoms are often nonspecific and may mimic [[Acute gastroenteritis\|acute gastroenteritis]]
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	===Workup===		===Workup===
	*Abdominal radiograph (AP view) — first-line imaging for all suspected ingestions		*Abdominal radiograph (AP view) — first-line imaging for all suspected ingestions
	**If magnets visualized on AP film, obtain a ~~'''~~lateral view~~'''~~ to help differentiate single vs. multiple magnets<ref name="NASPGHAN2012">Hussain SZ, Bousvaros A, Gilger M, et al. Management of Ingested Magnets in Children. ''J Pediatr Gastroenterol Nutr''. 2012;55(3):239-242. doi:10.1097/MPG.0b013e3182687f2f</ref>		**If magnets visualized on AP film, obtain a lateral view to help differentiate single vs. multiple magnets<ref name="NASPGHAN2012">Hussain SZ, Bousvaros A, Gilger M, et al. Management of Ingested Magnets in Children. ''J Pediatr Gastroenterol Nutr''. 2012;55(3):239-242. doi:10.1097/MPG.0b013e3182687f2f</ref>
	***Multiple magnets stacked together may appear as a single object on AP view		***Multiple magnets stacked together may appear as a single object on AP view
	***Lateral view may reveal separation or layering that suggests multiple pieces		***Lateral view may reveal separation or layering that suggests multiple pieces
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	===Diagnosis===		===Diagnosis===
	*Diagnosis is confirmed by visualization of metallic foreign body on radiograph in the setting of known or suspected magnet exposure		*Diagnosis is confirmed by visualization of metallic foreign body on radiograph in the setting of known or suspected magnet exposure
	*Critical determination is ~~'''~~single vs. multiple magnets~~'''~~, which dictates the management pathway		*Critical determination is single vs. multiple magnets, which dictates the management pathway
	**History alone may be unreliable — assume multiple magnets if unable to confirm definitively<ref name="NASPGHAN2015">Kramer RE, Lerner DG, Lin T, et al. Management of Ingested Foreign Bodies in Children: A Clinical Report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574. doi:10.1097/MPG.0000000000000729</ref>		**History alone may be unreliable — assume multiple magnets if unable to confirm definitively<ref name="NASPGHAN2015">Kramer RE, Lerner DG, Lin T, et al. Management of Ingested Foreign Bodies in Children: A Clinical Report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574. doi:10.1097/MPG.0000000000000729</ref>
	*If single vs. multiple cannot be reliably distinguished, ~~'''~~manage as multiple~~'''~~		*If single vs. multiple cannot be reliably distinguished, manage as multiple

	==Management==		==Management==
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	====Asymptomatic patient====		====Asymptomatic patient====
	*If magnets are in the ~~'''~~esophagus or stomach~~'''~~ → endoscopic removal<ref name="NASPGHAN2012"/>		*If magnets are in the esophagus or stomach → endoscopic removal<ref name="NASPGHAN2012"/>
	*If magnets are ~~'''~~beyond the pylorus:~~'''~~		*If magnets are beyond the pylorus:
	**Serial abdominal radiographs every 4-6 hours to assess progression<ref name="Altokhais2021"/>		**Serial abdominal radiographs every 4-6 hours to assess progression<ref name="Altokhais2021"/>
	**If magnets ~~'''~~progress~~'''~~ distally on serial imaging → may continue observation with close follow-up and serial imaging until passage confirmed		**If magnets progress distally on serial imaging → may continue observation with close follow-up and serial imaging until passage confirmed
	**If magnets '''do not progress''' within 6 hours → removal indicated (endoscopic or surgical)<ref name="Altokhais2021"/>		**If magnets '''do not progress''' within 6 hours → removal indicated (endoscopic or surgical)<ref name="Altokhais2021"/>
	**Consider polyethylene glycol (PEG) whole bowel irrigation to facilitate passage<ref name="NASPGHAN2015"/>		**Consider polyethylene glycol (PEG) whole bowel irrigation to facilitate passage<ref name="NASPGHAN2015"/>
	*Keep patient ~~'''~~NPO~~'''~~ until definitive management plan established		*Keep patient NPO until definitive management plan established
	*'''Do not use''' a magnet placed externally on the abdomen to attempt to move ingested magnets		*'''Do not use''' a magnet placed externally on the abdomen to attempt to move ingested magnets

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2026-03-19T16:04:35Z

Formatting: moved intro to Background bullets, removed excessive bold from bullet lead-ins

← Older revision		Revision as of 16:04, 19 March 2026
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	Magnet ingestion is a special category of [[Ingested foreign body\|ingested foreign body]] associated with high morbidity and mortality, particularly when multiple high-powered magnets or a magnet with another metallic object are swallowed.<ref name="Altokhais2021">Altokhais T. Magnet Ingestion in Children Management Guidelines and Prevention. ''Front Pediatr''. 2021;9:727988. doi:10.3389/fped.2021.727988</ref>		==Background==
			*Magnet ingestion is a special category of [[Ingested foreign body\|ingested foreign body]] associated with high morbidity and mortality, particularly when multiple high-powered magnets or a magnet with another metallic object are swallowed.<ref name="Altokhais2021">Altokhais T.
			*Magnet Ingestion in Children Management Guidelines and Prevention. ''Front Pediatr''. 2021;9:727988. doi:10.3389/fped.2021.727988</ref>


	~~==Background==~~
	*Most commonly occurs in children <5 years of age, with a second peak in adolescents (ages 10-14) who use magnets to mimic oral/nasal piercings<ref name="Silverman2013">Silverman JA, Brown JC, Willis MM, Ebel BE. Increase in pediatric magnet-related foreign bodies requiring emergency care. ''Ann Emerg Med''. 2013;62(6):604-608.e1. doi:10.1016/j.annemergmed.2013.06.023</ref>		*Most commonly occurs in children <5 years of age, with a second peak in adolescents (ages 10-14) who use magnets to mimic oral/nasal piercings<ref name="Silverman2013">Silverman JA, Brown JC, Willis MM, Ebel BE. Increase in pediatric magnet-related foreign bodies requiring emergency care. ''Ann Emerg Med''. 2013;62(6):604-608.e1. doi:10.1016/j.annemergmed.2013.06.023</ref>
	*Adult cases are rare and typically associated with psychiatric disorders, intellectual disability, or self-harm<ref name="Carvalho2025">Carvalho R, et al. Enteroenteric Fistula Following Multiple Magnet Ingestion in an Adult: Case Report, Literature Review and Management Algorithm. ''Healthcare''. 2025;13(19):2523. doi:10.3390/healthcare13192523</ref>		*Adult cases are rare and typically associated with psychiatric disorders, intellectual disability, or self-harm<ref name="Carvalho2025">Carvalho R, et al. Enteroenteric Fistula Following Multiple Magnet Ingestion in an Adult: Case Report, Literature Review and Management Algorithm. ''Healthcare''. 2025;13(19):2523. doi:10.3390/healthcare13192523</ref>
	*Rare-earth (neodymium) magnets are up to 10 times stronger than conventional ferrite magnets and pose the greatest risk		*Rare-earth (neodymium) magnets are up to 10 times stronger than conventional ferrite magnets and pose the greatest risk
	*Incidence has risen significantly since 2002, correlating with availability of high-powered magnet desk toys and building sets<ref name="Reeves2018">Reeves PT, Nylund CM, Krishnamurthy J, Noel RA, Abbas MI. Trends of magnet ingestion in children, an ironic attraction. ''J Pediatr Gastroenterol Nutr''. 2018;66(5):e116-e121. doi:10.1097/MPG.0000000000001822</ref>		*Incidence has risen significantly since 2002, correlating with availability of high-powered magnet desk toys and building sets<ref name="Reeves2018">Reeves PT, Nylund CM, Krishnamurthy J, Noel RA, Abbas MI. Trends of magnet ingestion in children, an ironic attraction. ''J Pediatr Gastroenterol Nutr''. 2018;66(5):e116-e121. doi:10.1097/MPG.0000000000001822</ref>
	*~~'''~~Single magnet~~'''~~ ingestion generally behaves like any other small blunt foreign body and usually passes without complication		*Single magnet ingestion generally behaves like any other small blunt foreign body and usually passes without complication
	*~~'''~~Multiple magnets~~'''~~ (or a magnet + metallic object) can attract across bowel walls, trapping intervening tissue and causing pressure necrosis within hours<ref name="Brown2014">Brown JC, Otjen JP, Drugas GT. Pediatric magnet ingestions: the dark side of the force. ''Am J Surg''. 2014;207(5):754-759. doi:10.1016/j.amjsurg.2013.12.028</ref>		*Multiple magnets (or a magnet + metallic object) can attract across bowel walls, trapping intervening tissue and causing pressure necrosis within hours<ref name="Brown2014">Brown JC, Otjen JP, Drugas GT. Pediatric magnet ingestions: the dark side of the force. ''Am J Surg''. 2014;207(5):754-759. doi:10.1016/j.amjsurg.2013.12.028</ref>
	**Pressure ulceration can occur within 8 hours of ingestion<ref name="GIKids">GIKids.org. Magnet Ingestions. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. https://gikids.org/digestive-topics/magnet-ingestions/</ref>		**Pressure ulceration can occur within 8 hours of ingestion<ref name="GIKids">GIKids.org. Magnet Ingestions. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. https://gikids.org/digestive-topics/magnet-ingestions/</ref>
	**Staggered ingestion (magnets swallowed at different times) is especially dangerous as magnets may lodge in different segments of bowel		**Staggered ingestion (magnets swallowed at different times) is especially dangerous as magnets may lodge in different segments of bowel
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	*Ingestion is frequently unwitnessed, especially in young children		*Ingestion is frequently unwitnessed, especially in young children
	*Symptoms are often nonspecific and may mimic [[Acute gastroenteritis\|acute gastroenteritis]]		*Symptoms are often nonspecific and may mimic [[Acute gastroenteritis\|acute gastroenteritis]]
	*~~'''~~Early symptoms:~~'''~~		*Early symptoms:
	**Gagging, choking, or drooling at time of ingestion (if witnessed)		**Gagging, choking, or drooling at time of ingestion (if witnessed)
	**Nausea, vomiting (most common presenting symptom)		**Nausea, vomiting (most common presenting symptom)
	**Abdominal pain		**Abdominal pain
	**Decreased oral intake		**Decreased oral intake
	*~~'''~~Late/complicated symptoms:~~'''~~		*Late/complicated symptoms:
	**Bilious vomiting		**Bilious vomiting
	**Abdominal distension and tenderness		**Abdominal distension and tenderness
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*~~'''~~Abdominal radiograph (AP view)~~'''~~ — first-line imaging for all suspected ingestions		*Abdominal radiograph (AP view) — first-line imaging for all suspected ingestions
	**If magnets visualized on AP film, obtain a '''lateral view''' to help differentiate single vs. multiple magnets<ref name="NASPGHAN2012">Hussain SZ, Bousvaros A, Gilger M, et al. Management of Ingested Magnets in Children. ''J Pediatr Gastroenterol Nutr''. 2012;55(3):239-242. doi:10.1097/MPG.0b013e3182687f2f</ref>		**If magnets visualized on AP film, obtain a '''lateral view''' to help differentiate single vs. multiple magnets<ref name="NASPGHAN2012">Hussain SZ, Bousvaros A, Gilger M, et al. Management of Ingested Magnets in Children. ''J Pediatr Gastroenterol Nutr''. 2012;55(3):239-242. doi:10.1097/MPG.0b013e3182687f2f</ref>
	***Multiple magnets stacked together may appear as a single object on AP view		***Multiple magnets stacked together may appear as a single object on AP view
	***Lateral view may reveal separation or layering that suggests multiple pieces		***Lateral view may reveal separation or layering that suggests multiple pieces
	**Serial radiographs every 4-6 hours (in ED) or 8-12 hours (inpatient) to assess progression		**Serial radiographs every 4-6 hours (in ED) or 8-12 hours (inpatient) to assess progression
	*~~'''~~Labs:~~'''~~ CBC, BMP, lipase if symptomatic; type and screen if concern for surgical intervention		*Labs: CBC, BMP, lipase if symptomatic; type and screen if concern for surgical intervention
	*~~'''~~CT abdomen/pelvis~~'''~~ — consider if concern for perforation, obstruction, or unclear radiograph findings		*CT abdomen/pelvis — consider if concern for perforation, obstruction, or unclear radiograph findings
	**Useful for identifying free air, free fluid, abscess		**Useful for identifying free air, free fluid, abscess
	**CT also lacks sensitivity for determining exact number of magnets<ref name="Altokhais2021"/>		**CT also lacks sensitivity for determining exact number of magnets<ref name="Altokhais2021"/>
	*~~'''~~Ultrasound~~'''~~ — emerging adjunct to assess for bowel loop entrapment between magnets<ref name="Haynes2023">Haynes SA, et al. Ultrasound evaluation of intraluminal magnets in an ex vivo model. ''Pediatr Radiol''. 2023;53(12):2418-2426. doi:10.1007/s00247-023-05763-7</ref>		*Ultrasound — emerging adjunct to assess for bowel loop entrapment between magnets<ref name="Haynes2023">Haynes SA, et al. Ultrasound evaluation of intraluminal magnets in an ex vivo model. ''Pediatr Radiol''. 2023;53(12):2418-2426. doi:10.1007/s00247-023-05763-7</ref>
	*'''MRI is absolutely contraindicated''' — ferromagnetic foreign bodies may migrate, heat, or cause perforation in the magnetic field<ref name="Bailey2012">Bailey JR, Eisner EA, Edmonds EW. Unwitnessed magnet ingestion in a 5 year-old boy leading to bowel perforation after magnetic resonance imaging. ''Patient Saf Surg''. 2012;6:16. doi:10.1186/1754-9493-6-16</ref>		*'''MRI is absolutely contraindicated''' — ferromagnetic foreign bodies may migrate, heat, or cause perforation in the magnetic field<ref name="Bailey2012">Bailey JR, Eisner EA, Edmonds EW. Unwitnessed magnet ingestion in a 5 year-old boy leading to bowel perforation after magnetic resonance imaging. ''Patient Saf Surg''. 2012;6:16. doi:10.1186/1754-9493-6-16</ref>

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	===Multiple magnets (confirmed or suspected)===		===Multiple magnets (confirmed or suspected)===
	*~~'''~~Consult pediatric surgery and/or GI early~~'''~~		*Consult pediatric surgery and/or GI early
	*Management depends on symptoms, location, and time since ingestion:		*Management depends on symptoms, location, and time since ingestion:

	====Symptomatic patient====		====Symptomatic patient====
	*~~'''~~Immediate removal~~'''~~ is indicated<ref name="Altokhais2021"/>		*Immediate removal is indicated<ref name="Altokhais2021"/>
	**Endoscopic removal if magnets are in the esophagus, stomach, duodenum, or colon		**Endoscopic removal if magnets are in the esophagus, stomach, duodenum, or colon
	**Surgical consultation if endoscopic removal fails or complications suspected		**Surgical consultation if endoscopic removal fails or complications suspected
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	==Disposition==		==Disposition==
	*~~'''~~Single confirmed magnet, asymptomatic:~~'''~~ may discharge with caregiver education, return precautions, and outpatient follow-up with serial imaging until passage confirmed		*Single confirmed magnet, asymptomatic: may discharge with caregiver education, return precautions, and outpatient follow-up with serial imaging until passage confirmed
	*~~'''~~Multiple magnets in esophagus or stomach:~~'''~~ admit for endoscopic removal		*Multiple magnets in esophagus or stomach: admit for endoscopic removal
	*~~'''~~Multiple magnets beyond the pylorus, progressing on serial films, asymptomatic:~~'''~~ may discharge with very close outpatient follow-up and serial imaging if reliable caregiver		*Multiple magnets beyond the pylorus, progressing on serial films, asymptomatic: may discharge with very close outpatient follow-up and serial imaging if reliable caregiver
	*~~'''~~Multiple magnets beyond the pylorus, not progressing:~~'''~~ admit for removal		*Multiple magnets beyond the pylorus, not progressing: admit for removal
	*~~'''~~Any symptomatic patient with multiple magnets:~~'''~~ admit; surgical consultation		*Any symptomatic patient with multiple magnets: admit; surgical consultation
	*After any endoscopic or surgical removal, confirm all magnet pieces accounted for (correlate with radiographic count); intraoperative radiograph if discrepancy		*After any endoscopic or surgical removal, confirm all magnet pieces accounted for (correlate with radiographic count); intraoperative radiograph if discrepancy
	*Patients should be observed for a minimum of 4-6 hours after endoscopic removal or presentation before discharge<ref name="NASPGHAN2012"/>		*Patients should be observed for a minimum of 4-6 hours after endoscopic removal or presentation before discharge<ref name="NASPGHAN2012"/>

Ostermayer: Created page with "Magnet ingestion is a special category of ingested foreign body associated with high morbidity and mortality, particularly when multiple high-powered magnets or a magnet with another metallic object are swallowed.Altokhais T. Magnet Ingestion in Children Management Guidelines and Prevention. ''Front Pediatr''. 2021;9:727988. doi:10.3389/fped.2021.727988 ==Background== *Most commonly occurs in children <5 years of..."

2026-03-17T22:42:49Z

Created page with "Magnet ingestion is a special category of ingested foreign body associated with high morbidity and mortality, particularly when multiple high-powered magnets or a magnet with another metallic object are swallowed.<ref name="Altokhais2021">Altokhais T. Magnet Ingestion in Children Management Guidelines and Prevention. ''Front Pediatr''. 2021;9:727988. doi:10.3389/fped.2021.727988</ref> ==Background== *Most commonly occurs in children <5 years of..."

New page

Magnet ingestion is a special category of [[Ingested foreign body|ingested foreign body]] associated with high morbidity and mortality, particularly when multiple high-powered magnets or a magnet with another metallic object are swallowed.<ref name="Altokhais2021">Altokhais T. Magnet Ingestion in Children Management Guidelines and Prevention. ''Front Pediatr''. 2021;9:727988. doi:10.3389/fped.2021.727988</ref>

==Background==
*Most commonly occurs in children <5 years of age, with a second peak in adolescents (ages 10-14) who use magnets to mimic oral/nasal piercings<ref name="Silverman2013">Silverman JA, Brown JC, Willis MM, Ebel BE. Increase in pediatric magnet-related foreign bodies requiring emergency care. ''Ann Emerg Med''. 2013;62(6):604-608.e1. doi:10.1016/j.annemergmed.2013.06.023</ref>
*Adult cases are rare and typically associated with psychiatric disorders, intellectual disability, or self-harm<ref name="Carvalho2025">Carvalho R, et al. Enteroenteric Fistula Following Multiple Magnet Ingestion in an Adult: Case Report, Literature Review and Management Algorithm. ''Healthcare''. 2025;13(19):2523. doi:10.3390/healthcare13192523</ref>
*Rare-earth (neodymium) magnets are up to 10 times stronger than conventional ferrite magnets and pose the greatest risk
*Incidence has risen significantly since 2002, correlating with availability of high-powered magnet desk toys and building sets<ref name="Reeves2018">Reeves PT, Nylund CM, Krishnamurthy J, Noel RA, Abbas MI. Trends of magnet ingestion in children, an ironic attraction. ''J Pediatr Gastroenterol Nutr''. 2018;66(5):e116-e121. doi:10.1097/MPG.0000000000001822</ref>
*'''Single magnet''' ingestion generally behaves like any other small blunt foreign body and usually passes without complication
*'''Multiple magnets''' (or a magnet + metallic object) can attract across bowel walls, trapping intervening tissue and causing pressure necrosis within hours<ref name="Brown2014">Brown JC, Otjen JP, Drugas GT. Pediatric magnet ingestions: the dark side of the force. ''Am J Surg''. 2014;207(5):754-759. doi:10.1016/j.amjsurg.2013.12.028</ref>
**Pressure ulceration can occur within 8 hours of ingestion<ref name="GIKids">GIKids.org. Magnet Ingestions. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. https://gikids.org/digestive-topics/magnet-ingestions/</ref>
**Staggered ingestion (magnets swallowed at different times) is especially dangerous as magnets may lodge in different segments of bowel

==Clinical Features==
*Many patients are '''asymptomatic''' in the early phase, leading to delayed presentation<ref name="Altokhais2021"/>
*Ingestion is frequently unwitnessed, especially in young children
*Symptoms are often nonspecific and may mimic [[Acute gastroenteritis|acute gastroenteritis]]
*'''Early symptoms:'''
**Gagging, choking, or drooling at time of ingestion (if witnessed)
**Nausea, vomiting (most common presenting symptom)
**Abdominal pain
**Decreased oral intake
*'''Late/complicated symptoms:'''
**Bilious vomiting
**Abdominal distension and tenderness
**Fever
**Signs of [[Peritonitis|peritonitis]] (guarding, rigidity, rebound tenderness)
**Hematemesis or melena (uncommon)
*Symptoms progress with increasing duration of ingestion and proximity of magnets across bowel walls

==Differential Diagnosis==
===[[Ingested foreign body]] (non-magnetic)===
*[[Button battery ingestion]]
*Coin ingestion
*Sharp/pointed object ingestion

===Abdominal pathology===
*[[Acute gastroenteritis]]
*[[Appendicitis]]
*[[Intussusception]]
*[[Small bowel obstruction]]
*[[Bowel perforation]]
*[[Volvulus]]

==Evaluation==
===Workup===
*'''Abdominal radiograph (AP view)''' — first-line imaging for all suspected ingestions
**If magnets visualized on AP film, obtain a '''lateral view''' to help differentiate single vs. multiple magnets<ref name="NASPGHAN2012">Hussain SZ, Bousvaros A, Gilger M, et al. Management of Ingested Magnets in Children. ''J Pediatr Gastroenterol Nutr''. 2012;55(3):239-242. doi:10.1097/MPG.0b013e3182687f2f</ref>
***Multiple magnets stacked together may appear as a single object on AP view
***Lateral view may reveal separation or layering that suggests multiple pieces
**Serial radiographs every 4-6 hours (in ED) or 8-12 hours (inpatient) to assess progression
*'''Labs:''' CBC, BMP, lipase if symptomatic; type and screen if concern for surgical intervention
*'''CT abdomen/pelvis''' — consider if concern for perforation, obstruction, or unclear radiograph findings
**Useful for identifying free air, free fluid, abscess
**CT also lacks sensitivity for determining exact number of magnets<ref name="Altokhais2021"/>
*'''Ultrasound''' — emerging adjunct to assess for bowel loop entrapment between magnets<ref name="Haynes2023">Haynes SA, et al. Ultrasound evaluation of intraluminal magnets in an ex vivo model. ''Pediatr Radiol''. 2023;53(12):2418-2426. doi:10.1007/s00247-023-05763-7</ref>
*'''MRI is absolutely contraindicated''' — ferromagnetic foreign bodies may migrate, heat, or cause perforation in the magnetic field<ref name="Bailey2012">Bailey JR, Eisner EA, Edmonds EW. Unwitnessed magnet ingestion in a 5 year-old boy leading to bowel perforation after magnetic resonance imaging. ''Patient Saf Surg''. 2012;6:16. doi:10.1186/1754-9493-6-16</ref>

===Diagnosis===
*Diagnosis is confirmed by visualization of metallic foreign body on radiograph in the setting of known or suspected magnet exposure
*Critical determination is '''single vs. multiple magnets''', which dictates the management pathway
**History alone may be unreliable — assume multiple magnets if unable to confirm definitively<ref name="NASPGHAN2015">Kramer RE, Lerner DG, Lin T, et al. Management of Ingested Foreign Bodies in Children: A Clinical Report of the NASPGHAN Endoscopy Committee. ''J Pediatr Gastroenterol Nutr''. 2015;60(4):562-574. doi:10.1097/MPG.0000000000000729</ref>
*If single vs. multiple cannot be reliably distinguished, '''manage as multiple'''

==Management==
===Single magnet (confirmed)===
*May be managed conservatively like other small blunt foreign bodies
*Outpatient observation with serial radiographs to confirm passage
*Ensure no co-ingestion of other metallic objects
*Caregiver education and return precautions

===Multiple magnets (confirmed or suspected)===
*'''Consult pediatric surgery and/or GI early'''
*Management depends on symptoms, location, and time since ingestion:

====Symptomatic patient====
*'''Immediate removal''' is indicated<ref name="Altokhais2021"/>
**Endoscopic removal if magnets are in the esophagus, stomach, duodenum, or colon
**Surgical consultation if endoscopic removal fails or complications suspected
**Surgical exploration (laparotomy or laparoscopy) if signs of [[Peritonitis|peritonitis]], [[Bowel perforation|perforation]], or [[Small bowel obstruction|obstruction]]

====Asymptomatic patient====
*If magnets are in the '''esophagus or stomach''' → endoscopic removal<ref name="NASPGHAN2012"/>
*If magnets are '''beyond the pylorus:'''
**Serial abdominal radiographs every 4-6 hours to assess progression<ref name="Altokhais2021"/>
**If magnets '''progress''' distally on serial imaging → may continue observation with close follow-up and serial imaging until passage confirmed
**If magnets '''do not progress''' within 6 hours → removal indicated (endoscopic or surgical)<ref name="Altokhais2021"/>
**Consider polyethylene glycol (PEG) whole bowel irrigation to facilitate passage<ref name="NASPGHAN2015"/>
*Keep patient '''NPO''' until definitive management plan established
*'''Do not use''' a magnet placed externally on the abdomen to attempt to move ingested magnets

===Complications of delayed treatment===
*[[Bowel perforation]]
*Pressure necrosis
*Enteroenteric, jejunocolic, or tracheoesophageal [[Fistula|fistula]]
*[[Small bowel obstruction]]
*[[Intussusception]]
*[[Volvulus]]
*Intra-abdominal or pelvic [[Abscess|abscess]]
*[[Peritonitis]] and [[Sepsis|sepsis]]
*Short gut syndrome (in severe cases requiring extensive resection)<ref name="NASPGHAN2012"/>
*Death (rare but reported)<ref name="Altokhais2021"/>

==Disposition==
*'''Single confirmed magnet, asymptomatic:''' may discharge with caregiver education, return precautions, and outpatient follow-up with serial imaging until passage confirmed
*'''Multiple magnets in esophagus or stomach:''' admit for endoscopic removal
*'''Multiple magnets beyond the pylorus, progressing on serial films, asymptomatic:''' may discharge with very close outpatient follow-up and serial imaging if reliable caregiver
*'''Multiple magnets beyond the pylorus, not progressing:''' admit for removal
*'''Any symptomatic patient with multiple magnets:''' admit; surgical consultation
*After any endoscopic or surgical removal, confirm all magnet pieces accounted for (correlate with radiographic count); intraoperative radiograph if discrepancy
*Patients should be observed for a minimum of 4-6 hours after endoscopic removal or presentation before discharge<ref name="NASPGHAN2012"/>
*Caregiver education on prevention: remove small high-powered magnets from the home environment

==See Also==
*[[Ingested foreign body]]
*[[Button battery ingestion]]
*[[Small bowel obstruction]]
*[[Bowel perforation]]
*[[Peritonitis]]
*[[Intussusception]]
*[[Foreign bodies]]

==External Links==
*[https://naspghan.org/files/documents/pdfs/cme/jpgn/Management_of_Ingested_Foreign_Bodies_in_Children_.28.pdf NASPGHAN Clinical Report: Management of Ingested Foreign Bodies in Children (2015)]
*[https://gikids.org/digestive-topics/magnet-ingestions/ GIKids.org — Magnet Ingestions]
*[https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.727988/full Altokhais T — Magnet Ingestion Management Guidelines and Prevention (2021)]

==References==
<references/>

[[Category:Pediatrics]]
[[Category:GI]]
[[Category:Toxicology]]