Ulus Travma Acil Cerrahi Derg. 2024; 30(5): 361-369 | DOI: 10.14744/tjtes.2024.50845

Chronic jejuno-colonic fistula and intestinal malabsorption due to multiple magnet ingestions: A case report and systematic review

Rahþan Özcan¹, Ali Ekber Hakalmaz¹, Ayþe Kalyoncu Uçar², Omer Beser³, Senol Emre^1
1Department of Pediatric Surgery, Ýstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Ýstanbul-Türkiye
²Department of Radiology, Ýstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Ýstanbul-Türkiye
³Department of Pediatric Gastroenterology, Ýstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Hepatology and Nutrition, Ýstanbul-Türkiye

Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.

Keywords: Intestinal volvulus, jejuno-colonic fistula; magnet ingestion.

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Çoklu mýknatýs yutulmasýna baðlý kronik jejuno-kolonik fistül ve intestinal malabsorbsiyon: Olgu sunumu ve sistematik inceleme

Rahþan Özcan¹, Ali Ekber Hakalmaz¹, Ayþe Kalyoncu Uçar², Omer Beser³, Senol Emre^1
1Ýstanbul Üniversitesi-Cerrahpaþa, Cerrahpaþa Týp Fakültesi, Çocuk Cerrahisi Anabilim Dalý, Ýstanbul, Türkiye
²Ýstanbul Üniversitesi-Cerrahpaþa, Cerrahpaþa Týp Fakültesi, Radyoloji Anabilim Dalý, Ýstanbul, Türkiye
³Ýstanbul Üniversitesi-Cerrahpaþa, Cerrahpaþa Týp Fakültesi, Çocuk Gastroenteroloji Anabilim Dalý, Ýstanbul, Türkiye

Çocuklarda mýknatýs yutulmasý akut ve kronik dönemde ciddi komplikasyonlara yol açabilen bir durumdur. Amacýmýz çoklu mýknatýs yutma hikayesi olan ve geç dönemde jejuno-kolonik fistül, baðýrsakta segmental volvulus, hepatosteatoz, renal kalkül saptanan bir olguda tedavi yaklaþýmýný sunmak ve mýknatýs yutulmasýna baðlý oluþan intestinal fistüllerin özelliklerini saptamak için literatür taramasý yapmaktýr. Çocuk gastroenteroloji bölümüne iki yýldýr aralýklý karýn aðrýsý, kusma ve ishal ataklarý ile baþvuran 6 yaþýndaki kýz çocuðu Çölyak hastalýðý, kistik fibrozis, enflamatuvar baðýrsak hastalýðý ve tüberküloz ön tanýlarýyla araþtýrýlmýþ, ancak etyoloji saptanamamýþtý. Magnetik rezonans görüntülemede jejuno-kolonik fistül þüphesi olmasý nede-niyle çocuk cerrahisine konsülte edildi. Fizik muayenede akut batýn bulgusu saptanmadý, hafif batýn distansiyonu mevcuttu. Üst gis pasaj ve lavman opak grafisinde jejuno-kolonik fistül ve segmenter volvulus saptandý. Aile tekrar sorgulandýðýnda, hastanýn 2 yýl önce mýknatýs yuttuðu, 1-2 hafta içinde mýknatýslarýn kendiliðinden dýþarý atýlmasý üzerine baþka bir merkezde takibe son verildiði bildirildi. Volvulus ve geniþ jejunokolonik fistül ne-deniyle cerrahi eksplorasyon yapýldý, segmenter volvulus düzeltildi ve jejuno-kolonik fistül onarýldý. Literatürdeki çalýþmalarý belirlemek için, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) kýlavuzlarýna göre mýknatýs alýmý ve gastrointestinal fistül hakkýnda ayrýntýlý bir araþtýrma yapýldý. Akut dönemde bulgu vermeyen, akut batýn tablosuna yol açmayan 55 olgu (44 makale) saptandý. Olgularýn 29’unda mýknatýsýn yutulma zamaný bilinmiyordu. Yabancý cisim yutma zamaný bilinen 26 olguda fistül saptanma zamaný ortalama 22,8 gün (1-90 gün) idi. Kýrkyedi olguda laparotomi ile fistül onarýmý yapýlmýþtý. Çocuklarda mýknatýs yutulmasý sonrasý asemptomatik olgularýn varlýðý, akut ve kronik dönemde intestinal fistüllerin oluþabileceði unutulmamalýdýr.

Anahtar Kelimeler: Ýntestinal volvulus, jejuno-kolonik fistül; mýknatýs yutma.

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