Журнал «Здоровье ребенка» 4 (47) 2013

Foreign objects of the digestive tract are often found in children. Each year, more than 100,000 foreign bodies are swallowed by children.

Most often foreign matters are swallowed by children aged from 9 months till 3 years. At localization of foreign matters in an esophagus or a stomach they are removed endoscopically. When foreign matters are moved in a duodenum and underlying departments of a digestive tube often they evacuated by natural way. The special attention should be paid to such aggressive foreign matters as toys "the magnetic - globules" which appeared in Ukraine recently. If the child swallows magnetic globules (two and more pieces), they are distributed in different departments of the digestive channel, attracted one to one, caused an obstruction of an intestine or intestine perforation with peritonitis development.

In the USA from 2008 to 2012 200 cases of the magnets swallowed by children were registered. The commission on control of safety of consumers of goods forbade realization of these toys in children's shops. The special attention deserves the publication J.Midgett, PHD et al. (2008) which reports about 20 cases of serious complications (an obstruction, peritonitis), arisen at children who have swallowed magnetic globules. Among these children one child died of complications. It is necessary to notice also that magnetic globules - toys are legislatively forbidden in the European Union countries.

In 2013 in clinic of children's surgery of DonNMU  there were 2 children with foreign matters of an intestine - magnetic globules. We provide the description of these two cases.

Clinical observation 1. The child M, 2 years 3 months  arrived in clinic 08.03.2013г at 16:50 from city Mariupol with complaints of parents that child swallowed globules magnets. Within 3 days the evacuation of foreign matters wasn't established. The child arrived in clinic for further treatment.

Children condition satisfactory, he is active. Stomach is the correct shape, soft, painless in all departments. Symptoms of a boring of a peritoneum are negative. Physiological departures are normal.

08.03.2013 EGD - foreign matters in a stomach isn't revealed. 08.03.2013 X-ray test of an abdominal cavity: in an abdominal cavity foreign matters ("globules") at the level of L-II-L-III are defined. General condition of the child stayed satisfactory. Complaints doesn't show, physiological departures are normal. Foreign matters didn't evacuate by natural way. 12.03.2013 repeatedly X-ray test of abdominal organs: the shadow of foreign matters remains at the same level in an abdominal cavity. Considering long exposition of foreign matters in an intestine, surgical treatment was prescribed to the child.

13.03.2013 operation: the median laparotomy, in an abdominal cavity isn't present an exudate. Foreign matters are found in a transversal bowel. Globules magnets as the clothespegs jammed a colon wall. The colotomy is made. Foreign matters - globules magnets in number of 11 pieces are removed through a colostomic hole. The colostomic hole was seawed by two-row seam. The postoperative wound is taken layer-by-layer in tightly. The postoperative period proceeded smoothly. The child in a satisfactory condition at the 9 day leaved the hospital.

Clinical observation 2.  Child of T. 1 years 2 months arrived in clinic 08.03.2013 at 00:10 from the city of Kramatorsk with complaints of parents that child swallowed globules magnets.

The general condition of the child satisfactory, it is active.  Stomach of the correct shape.  The child doesn't react to a stomach palpation.  Physiological departures are normal.

08.03.2013г EGD - foreign matters in a stomach and a duodenum wasn't revealed. 08.03.2013 X-ray test of an abdominal cavity: shadows of X-ray contrast foreign matters ("beads") are determined in an abdominal cavity at the level of LIII by the average line. In 3 days foreign matters didn't evacuate by a natural way. Body temperature of the child increased to 37.4C, however the general condition remained satisfactory.

13.03.2013 repeatedly X-ray test of abdominal organs: foreign matters are on the same place, but got a form of the ring consisting of separate globules. Surgical treatment is prescribed.

13.03.2013 operation:  The upeermedian laparotomy, in an abdominal cavity isn't present a free exudate.  It was established that globules magnets punched in two places a jejunum at distance of 5 cm from ligament of Treitz and, having left an intestine lumen, were linked outside of intestine in the form of a ring. Foreign matters in number of 21 globules are taken from an intestine through the bottom perforative hole.  Perforative holes were seawed by a two-row seam.  The abdominal cavity is taken layer-by-layer in tightly.

The postoperative period proceeded smoothly. The child in a satisfactory condition at the 9 day leaved the hospital.

Conclusions:

1. Foreign matters of a digestive tube with magnetic properties are very dangerous.
2. Children who swallowed magnetic globules have to be treated at surgical hospital.
3. When magnets fixe in the digestive channel medical tactics has to be active. Excision of foreign matters prevents development of serious complications: intestinal obstruction, perforation, peritonitis.