Revisiting swallowed troubles: intestinal complications caused by two magnets--a case report, review and proposed revision to the algorithm for the management of foreign body ingestion.

Accidental ingestion of foreign bodies and its management is a common problem seen more in the pediatric population than in adults. A review of the literature suggests that endoscopic removal of foreign bodies is curative for objects located in the cricopharynx or upper esophagus. Foreign bodies passed into the stomach can usually be observed for development of symptoms, because 80% of them would be spontaneously passed. However, ingestion of metallic foreign bodies involving coins or button-type batteries may require an aggressive approach. A few cases of intestinal obstruction due to magnet ingestion have been reported in Japan, China, and Korea where magnets are used for treatment in traditional medicine. When more than one magnet is ingested they can be attracted to each other through the intestinal wall, causing necrosis and intestinal perforation or fistula, so they should be removed while they are still accessible with endoscope. We report a case for the first time in the United States of intestinal obstruction and fistula formation due to ingestion of more than one magnet. We feel that early endoscopic removal of magnets or a magnet along with a magnetic foreign body is safe and should be the choice of management. The author proposes an algorithm for management of foreign body ingestion focusing on early retrieval of magnetic foreign bodies.