Algorithm-driven management of pediatric multiple magnetic foreign bodies: a single-center experience of 171 cases

To delineate the clinical features of pediatric multiple magnetic foreign body ingestion and evaluate the clinical decision-making criteria for endoscopic, surgical, or conservative management.

A retrospective cohort study was conducted on pediatric patients diagnosed with multiple magnetic foreign body ingestion at the Children's Hospital Affiliated to Zhengzhou University between January 2019 and October 2025. Following the collection of comprehensive clinical data, the cohort was stratified into subgroups based on the specific intervention methods employed for foreign body removal. Demographic data, clinical manifestations, triage modalities, and outcomes were analyzed.

The cohort comprised 171 patients (120 males; median age 3.42 years), with a median ingestion-to-intervention interval of 1.5 days. A definitive ingestion history was lacking in 41.52% of cases. The cohort was triaged into a non-surgical group (n = 50; 40 endoscopic retrievals and 10 spontaneous passages under conservative observation) and a surgical group (n = 121). Gastrointestinal perforations occurred in 108 cases (63.16% of this referred cohort), predominantly in the small intestine. Symptomatic presentation (abdominal pain, vomiting) and absent bowel sounds were strong clinical indicators for severe transmural injury and surgical intervention. All patients were successfully discharged without mortality, although 12 cases required reoperation for postoperative adhesive intestinal obstruction.

Multiple magnetic foreign body ingestion carries a profound risk of occult transmural perforation, demanding aggressive, algorithm-driven triage in tertiary care settings. Urgent endoscopic retrieval is prioritized for accessible proximal magnetic foreign bodies, while asymptomatic distal ingestions may be managed with strict inpatient conservative observation. However, the onset of abdominal symptoms, failure of radiographic progression, or unsuccessful endoscopic retrieval mandates immediate surgical exploration. During surgery, a complete intraoperative bowel exploration is imperative to prevent missed multifocal injuries.