Liu Yegen,Li Ganglong,Luo Qiumei,et al.Accidental ingestion of metallic magnetic foreign bodies:a report of six cases with a literature review[J].Journal of Clinical Pediatric Surgery,2022,21(12):1185-1190.[doi:10.3760/cma.j.cn101785-202104060-016]
小儿消化道磁性金属异物6例及文献复习
- Title:
- Accidental ingestion of metallic magnetic foreign bodies:a report of six cases with a literature review
- Keywords:
- Foreign Bodies; Metal; Buckeyball; Gastrointestinal Tract; Injuries; Endoscopy; Gastrointestinal; Child
- 摘要:
- 目的 总结小儿消化道磁性金属异物的治疗经验。方法 回顾性分析2019年1月至2020年12月广东省妇幼保健院小儿普外科收治的6例误食磁性金属异物患儿临床资料,并检索万方、中国知网及PubMed数据库(2015年1月1日至2020年12月31日)中相关儿童误食磁性金属异物的文献进行复习,总结患儿临床特征、治疗方法、转归及预后。结果 本院6例患儿发病年龄2~6岁,误食磁性金属异物数目为2~11颗。3例无症状,3例有不同程度腹痛、呕吐不适。1例经肛门自行排出磁性金属异物;5例经手术取出磁性金属异物,其中2例行肠修补或肠吻合根治术;2例先行肠造口术,后行肠造口闭合术;1例术中见消化道无损伤,将异物推至结肠自肛门取出。共检索到10篇符合纳入标准的文献,共报道47例患儿,其中4例吞入磁性金属异物1颗(均经肛门自行排出);3例一次性吞入多颗(≥2颗),1例经肛门自行排出,2例经内镜下取出;40例分次吞入多颗,4例经内镜下取出,36例经手术取出;28例详细记录了发病时间,9例发病时间≤2 d者中,合并消化道穿孔2例;19例发病时间>2 d者中,合并消化道穿孔17例;35例就诊时有腹痛、呕吐,12例无症状;腹部体征阴性38例,腹部压痛7例,腹胀2例;合并消化道穿孔34例,其中5例为单部位穿孔,29例为多部位穿孔(≥2个)。36例手术患儿中,2例术中发现消化道未穿孔,均通过切开小肠壁取出异物;合并腹腔感染10例,合并部分肠管坏死1例,肠梗阻2例,单纯消化道瘘25例,合并胃、十二指肠、小肠穿孔共30例(27例行肠修补或肠吻合根治术;3例行肠造口术,后行造口闭合术),合并结肠穿孔4例(4例均行肠穿孔修补或肠吻合根治术)。所有患儿预后良好。结论 小儿误食单颗或一次性误食多颗磁性金属异物大多可自行排出或经内镜下取出,分次吞食多颗磁性金属异物经肛门自行排出的可能性非常低,需及时通过内镜或手术将异物取出。发病时间超过2 d将增加合并消化道穿孔的概率。合并胃、十二指肠、小肠及结肠穿孔者可行一期肠穿孔修补或吻合术,手术方式的选择需根据穿孔部位肠壁情况及手术医师经验决定。
- Abstract:
- Objective To summarize the experiences of treating magnetic metal foreign body in alimentary tract of children.Methods From January 2019 to December 2020,clinical data were retrospectively reviewed for 6 children ingesting magnetic metal foreign bodies.Literature reports related to children ingesting magnetic metal foreign bodies were retrieved from the databases of Wanfang,CNI and PubMed from January 1,2015 to December 31,2020.And clinical characteristics,treatments and outcomes were analyzed.Results The age of onset was (2-6) years and the number of ingested magnetic metal foreign bodies (2-11).Clinical manifestations were non-specific (n=3) and abdominal pain with varying vomiting (n=3).Except for 1 case of excreting through anus,the remainders were surgically removed.Intestinal repair or radical operation of intestinal anastomosis (n=2) and enterostomy plus closed enterostomy (n=2) were performed.In another case,digestive tract remained intact and foreign body was extracted from anus.A total of 10 literatures fulfilling the inclusion criteria were retrieved with a total of 47 children.Four cases swallowed a magnetic metal foreign body and passed it through anus.Three cases swallowed multiple pills at one time.Two cases underwent initial enterostomy and two patients were removed under endoscope.Among 40 cases of multiple ingestion,endoscopic (n=4) and surgical (n=36) extractions were performed.The onset time of 28 cases was recorded.Among 19 cases with onset time >2 days,17 cases were complicated with digestive tract perforation.There were abdominal pain & vomiting (n=35) and non-symptom (n=12).There were negative abdominal signs (n=38),abdominal tenderness (n=7) and abdominal distension (n=2).Among 34 cases complicated with digestive tract perforation,perforation was single (n=5) and multiple (n=29).Among 36 surgical cases,2 cases had no digestive tract perforation and foreign body was removed via an incision of small intestinal wall.The complications were abdominal infection (n=10),partial intestinal necrosis (n=1),intestinal obstruction (n=2) and simple digestive tract fistula (n=25).Among 30 perforated cases of stomach,duodenum and small intestine,intestinal repair or radical enterostomy (n=27) and enterostomy plus stomy closure (n=3) were performed.Four cases of colonic perforation underwent intestinal repair or radical enterostomy.All patients had a decent prognosis.Conclusion Children mistakenly ingesting a single magnetic metal foreign body or multiple magnetic metal foreign bodies at one time may be treated by endoscope.There is a low possibility of multiple magnetic metal foreign bodies to be discharged by anus and timely removal should be performed by endoscope or surgery.A delay of longer than 2 days will elevate the risk of gastrointestinal perforation.For a perforation of stomach,duodenum,small intestine and colon,one-stage repair or anastomosis of intestinal perforation is feasible.Selecting surgical approaches should be based upon operator experiences and the condition of intestinal wall at perforation site.
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备注/Memo
收稿日期:2021-4-25。
通讯作者:吕成超,Email:403105666@qq.com