ORIGINAL ARTICLE Bowel injuries caused by ingestion of multiple magnets in children: a growing hazard Hussein Naji • Daniel Isacson • Jan F. Svensson • Tomas Wester Accepted: 14 November 2011 / Published online: 30 November 2011 Ó Springer-Verlag 2011 Abstract Purpose There are no definite guidelines on the man- agement of ingested magnetic objects in children. The aim of this study was to present our experience and to highlight the importance of strict follow-up. Methods Within 6 months period, four children presented to the emergency department after ingestion of multiple magnets. We reviewed retrospectively the patients’ documents, radiological reports, operative findings and outcome. We also performed a literature search for all reports of multiple magnets ingestion on MEDLINE and EMBASE. Results Daily abdominal radiographs to monitor migra- tion of magnetic objects together with clinical examination revealed early detection of perforations in two patients. Explorative laparoscopy and suturing of perforations resulted in a rapid recovery and good cosmetic appearance. Literature search resulted in 44 published articles with a total of 52 cases of multiple magnet ingestion in children. Conclusions This report stresses the need for prompt follow-up and early detection of complications in order to operate those patients without delay. Laparoscopy is the method of choice in exploring the abdomen when perfo- ration is suspected. Keywords Magnet ingestion Á Multiple magnets Á Bowel perforation Á Explorative laparoscopy Á Children Introduction Children are well known to ingest foreign materials as they experiment throughout their development. Magnetic object ingestion is, however, very rare, but do occur and it is very important that the hazards of ingesting magnetic bodies are well known to the physician. Bowel perforation following magnetic material ingestion has been well documented in the literature [1–5]; however, there are no definite guide- lines on the management of ingested magnetic objects in children. In isolation, a single magnet is typically innocu- ous and is expected to behave much like other foreign bodies, however, several reports in surgical and pediatric journals proclaim the danger in children whenever more than one swallowed magnet travels beyond the stomach [2]. The force of multiple magnets that attract each other has been reported to be 1,300 G [6]. The magnets will hold the intestinal wall in between them and result in ischemia, pressure necrosis, perforation, fistula formation and/or intestinal obstruction [3]. The aim of this report was to present our experience with ingested magnets in children. An aggressive follow-up is stressed as migration of the magnetic objects only allows for greater morbidity. Patients and methods Four children who ingested multiple magnets presented to the emergency department in Astrid Lindgren Children’s Hospital in Stockholm, from January 2011 through June 2011. The clinical reports, radiological findings and oper- ative notes were reviewed retrospectively. We describe each case separately to give a better clue on the findings Hussein Naji and Daniel Isacson have contributed equally to the work. H. Naji (&) Á D. Isacson Á J. F. Svensson Á T. Wester Astrid Lindgren Children’s Hospital, Karolinska University, Stockholm, Solna, Sweden e-mail: hussein.naji@karolinska.se 123 Pediatr Surg Int (2012) 28:367–374 DOI 10.1007/s00383-011-3026-x