COMMENTARY

Neodymium Magnets: Too Attractive?

William F. Balistreri, MD

Disclosures

March 12, 2014

In This Article

Not Your Ordinary Magnets

Supermagnets became popular approximately 15 years ago, when they appeared as components of various devices and novelty items. Later, they were aggressively marketed as "desk toys" for adults -- "stress relievers" in the form of sculptures and puzzles, for example. These sets were labeled as being "not for use by children"; nonetheless, they exerted a strong attraction for children.

Many of these sets contained 100-200 high-powered magnets, which are difficult to account for once the set is removed from its original packaging.[12] At first glance, these neodymium/iron/boron magnets appear innocuous -- small (2-5 mm), smooth, and spherical -- characteristics of an object that should easily complete the route from ingestion to excretion.

However, there is a literal catch: Neodymium magnets are much stronger than traditional magnets, and are thus capable of attracting each other with formidable forces. Thus, whereas one magnet will indeed be easily passed, when 2 or more are coingested, the magnetic attraction between the wandering objects in vicinal loops of the bowel ensues, with dire consequences. The forceful binding across the bowel wall causes pressure necrosis, leading to bowel ulceration and intestinal perforation.

A consumer education video dramatically demonstrates the sequence of events. The child is usually without symptoms until the moment of perforation and the onset of peritonitis. Without prompt recognition, sepsis and death can result.

A Case Example

A reported example is that of a healthy 3-year-old boy who was brought to the ED because his mother was concerned that "he ate several small, spherical magnets."[14] His only symptom was increased drooling, and his physical examination was unremarkable. Abdominal radiographs were obtained that demonstrated magnets in the epigastrium and right lower quadrant of the abdomen. An endoscopic examination of the proximal jejunum was performed, with hopes of retrieval; however, the magnet had migrated beyond reach. The child was discharged with advice to "monitor his stool" and was given laxatives.

Two days later, despite watery bowel movements, he did not pass the magnets. Furthermore, he had onset of fever, tachycardia, and abdominal pain. Repeat radiography demonstrated that the magnets were conjoined in the right lower quadrant. At laparoscopy, 3 neodymium magnets, adhering to each other, were found to have eroded through 2 loops of ileum. The patient underwent primary repair of the perforation.

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