Pediatric rare earth magnet ingestion: Defining "progression" in serial abdominal imaging

Ingestion of rare earth magnets (REMs) results in significant morbidity and mortality in children, thus patients are frequently admitted to monitor REM progression. Short of peritonitis, unsuccessful or successful progression of REMs is ill-defined. Our goal was to determine if REM midline crossing on serial films was associated with decreased risk of surgical intervention.

A retrospective cohort study was conducted of patients less than 18 years old admitted to a children's hospital following REM ingestion from 1/1/2013-9/30/2024. Symptoms, serial radiograph findings, and management data were collected. Continuous measures are calculated as mean/standard deviation (SD) when normally distributed and median/percentile if skewed. Categorical measures are shown as frequencies/percentages.

In total, 31 patients were included. Mean (SD) age was 8.2 (4.0) years, ranging 3-14 years, with a male predominance of 1.6:1 (61.3 %). For 77.4 %, time of ingestion was known. Mean (SD) time to presentation was 10.7 (18.8) hours, ranging 0.5-78.5 h. The mean (SD) number of ingested REMs was 6 (11), ranging 2-68. In 41.9 % of cases, REMs were ingested simultaneously. In 58.1 %, synchronicity was uncertain. 19 patients (59.4 %) had an intervention: 16 endoscopies, 3 surgical. 5 patients required a second intervention: 1 lower endoscopy, 4 surgical. Patients with at least one midline crossing of REMs were less likely to require surgery (16.7 %, 81.8 %) with a relative risk of 0.044 (95%CI 0.004-0.49) (p < 0.001).

Midline REM crossing provided an indicator of progression through the gastrointestinal tract with a higher likelihood of passage without surgery. In our series, no patients required surgery if REMs were observed to cross midline more than once.