Несъедобные магниты

dok_zlo — 23.11.2024

Small-Bowel Obstruction and Intestinal Fistula from Accidental Ingestion of Magnets
A previously healthy 18-month-old girl was brought to the emergency department with sudden-onset abdominal distention that had been preceded by 3 days of diarrhea and 1 day of vomiting. On physical examination, the patient appeared lethargic and dehydrated. The abdomen was markedly distended with decreased bowel sounds, but there was no tenderness or guarding. An abdominal radiograph, obtained with the patient in the supine position, showed three circular radiopaque objects in the intestines, along with dilated loops of bowel (Panel A). Owing to concern about ingestion of a foreign body, an emergency exploratory laparotomy was performed. An ileocecal fistula (Panel B, circle) created by the union of three magnetic beads was identified (arrow, cecum; asterisk, ileum), and dilated loops of bowel were noted. The magnetic beads — which were later identified by the patient’s parents as coming from a toy composed of magnetic beads — were removed, and the bowel was repaired. A diagnosis of small-bowel obstruction and an intestinal fistula from accidental ingestion of magnets was made. Small magnets should be kept out of reach of children to prevent serious gastrointestinal complications of ingestion, such as tissue necrosis, fistulization, perforation, volvulus, or obstruction. The patient was discharged home on postoperative day 5. At the 2-week follow-up, her symptoms had abated and normal bowel function had returned.
Authors: Gaurav Prasad, M.Ch., and Vishesh Jain, M.Ch.
Published November 20, 2024
N Engl J Med 2024;391: e48
DOI: 10.1056/NEJMicm2406137
VOL. 391 NO. 20

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