Question

A previously healthy 18-month-old girl was brought to the emergency department with sudden-onset abdominal distention that had been preceded by 3 days of diarrhea and 1 day of vomiting. On physical examination, the patient appeared lethargic and dehydrated. The abdomen was markedly distended with decreased bowel sounds, but there was no tenderness or guarding. An abdominal radiograph, obtained with the patient in the supine position, showed three circular radiopaque objects in the intestines, along with dilated loops of bowel.

What is the most appropriate next step in this case?

Options:

1. Colonoscopy retrieval

2. Emergency exploratory laparotomy

3. Laxatives

4. Observation and monitoring

5. Serial imaging

Ingestion of Multiple Magnets
⬇️
🧠 Magnets Attract Across Bowel Loops

Compresses adjacent bowel walls
⬇️
Compression of Bowel Walls
⬇️
🧠 Ischemia and Necrosis

Reduced blood supply to affected segments of bowel
⬇️
Inflammatory Response
⬇️
Distension and Ileus

Accumulation of gas and fluid due to impaired motility
⬇️
🧠 Obstruction Develops

Bowel cannot effectively move contents
⬇️
Signs and Symptoms Manifest

Abdominal distension

Decreased bowel sounds

Vomiting

Dehydration (due to fluid loss from diarrhea and vomiting)
⬇️
Progression of Untreated Condition
⬇️
🧠 Risk of Perforation

Magnets erode through bowel walls
⬇️
Peritonitis

Leakage of bowel contents into the peritoneal cavity
⬇️
Sepsis and Life-Threatening Complications
⬇️
Requires Emergency Exploratory Laparotomy

🧠 Radiologic Findings:

Radiopaque objects: Suggestive of swallowed magnets.

Dilated bowel loops: Indicative of obstruction or ileus.

Explanation of Other Answers

Colonoscopy retrieval:

Not feasible for proximal foreign objects or multiple magnets due to risk of mucosal tears or failure to remove.

Laxatives:

Contraindicated due to risk of perforation and worsening obstruction/ischemia.

Observation and monitoring:

Insufficient given the immediate risk of perforation and peritonitis.

Serial imaging:

Delays definitive treatment and does not address the underlying obstruction or ischemia.

Flashcards

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