小儿误食多枚磁铁异物八例诊治体会

Diagnosis and treatment of 8 cases of children ingesting multiple magnetic foreign bodies by mistake

目的探讨误食多枚磁铁消化道异物的临床特征,复习既往文献资料,为临床治疗提供参考。方法回顾性分析8例就诊于山西省儿童医院的误食多枚磁铁异物患儿的临床表现、治疗过程和转归,并复习相关文献。结果8例误食多枚磁铁的患儿年龄1~9岁,病史时间5 h^2个月。误食磁铁数目2~25枚。术中发现6例有多处肠管穿孔,1例形成内瘘,2例形成腹内疝,穿孔最少2处,最多6处。穿孔部位位于食管远端、胃、十二指肠、空肠及回肠、结肠。7例急诊手术治疗,1例经结肠镜取出后肠梗阻,保守治疗好转出院。7例手术方式中1例行单纯修补术,1例行胃空肠吻合术、肠穿孔修补术,2例行2处肠管肠切除肠吻合术,2例行1处肠切除肠吻合术+余处穿孔修补术,1例内瘘患儿行腹腔镜探查、扩大切口肠切除肠吻合术。7例病例经手术治疗后均顺利恢复,1例结肠镜取出异物后肠梗阻患儿经保守治疗9 d后恢复,随访至今无并发症发生。我们结合经验及文献资料完善了小儿误食磁铁异物诊治流程。结论误食多枚磁铁可致多处消化道穿孔及腹内疝、肠梗阻等严重病情,需尽早进入诊治流程。应加强对小儿误食多枚磁铁异物的认识,早期发现早期治疗。

Objective To explore the clinical characteristics of multiple magnetic digestive tract foreign bodies ingested by mistake, to review the previous literature and provide reference for clinical treatment. Methods The clinical data, treatment process and outcome of 8 cases of children with multiple magnetic foreign bodies admitted to Shanxi Children′s Hospital were retrospectively analyzed, and relevant literatures were reviewed. Results Eight children with multiple magnets were aged 1 to 9 years old, and their medical history ranged from 5 hours to 2 months.Number of magnets ingested was 2-25.During the operation, 6 patients were found with multiple intestinal perforations, 1 with internal fistula and 2 with internal abdominal hernia, with at least 2 perforations and at most 6 perforations.The perforation sites located in the distal esophagus, stomach, duodenum, jejunum, ileum and colon.Seven cases were treated by emergency surgery, and 1 case was removed by colonoscopy and discharged after conservative treatment.One case underwent simple repair, 1 case underwent gastrojejunostomy, intestinal perforation repair;partial intestinal resection was performed in 2 places in 2 cases;partial intestinal resection was performed in 1 place and simple repair in the other places in 2 case;1 case of fistula in child with intestinal anastomosis laparoscopic exploration, incision bowel resection.Seven cases recovered after surgical treatment.The child with intestinal obstruction after colonoscopy was discharged uneventfully 9 days later by conservative treatment, no complications occurred by followed-up.Combined with experience and literature, we developed a management algorithm for digestive tract magnet foreign body. Conclusion Accidental ingestion of multiple magnets can cause multiple digestive tract perforations, internal hernia, intestinal obstruction and other serious diseases, which should be treated as soon as possible.Therefore, it is necessary to strengthen the understanding of multiple magnet foreign bodies in children, early detection and early treatment.