Clinical characteristics and therapeutic experiences of magnetic foreign body ingestion in children: a single-center retrospective study

Introduction

In recent years, the ingestion of multiple magnetic foreign bodies (MMFBs) in children has increased rapidly, driven by the introduction and popularity of “buckyball” magnetic bead toys (1). Unlike other ingested gastrointestinal foreign bodies, MMFB can adhere across the digestive system, potentially causing gastrointestinal perforation, intestinal necrosis, and ileus, which may lead to peritonitis and, in severe cases, become life-threatening (2,3). Once diagnosed, prompt and appropriate therapy should be administered. Although numerous reports on MMFBs exist, most are case reports or small case series, which hinder an accurate understanding of the true nature of this clinical entity (2,4,5). Currently, there is no international consensus on the management of MMFB (3).

This study retrospectively analyzed the clinical data of 160 patients with MMFB ingestion who were hospitalized at our institution over the past 10 years. We aimed to summarize their clinical characteristics and treatment experiences to provide evidence for rational clinical management. We present this article in accordance with the STROBE reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0216/rc).

Methods

Participants and clinical data

We retrospectively reviewed the medical records of 160 patients treated for MMFB ingestion at the Children’s Hospital of Zhejiang University School of Medicine (CHZU) between June 2016 and August 2025. This study was approved by the Ethics Committee of Children’s Hospital, Zhejiang University School of Medicine (approval No. 2025-IRB-0422-P-01). Informed consent was obtained from all patients’ legal guardian prior to inclusion. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This The inclusion criteria were age under 18 years, presence of a gastrointestinal foreign body diagnosed by abdominal X-ray or computed tomography at CHZU, and the presence of two or more magnetic foreign bodies. Patients with MMFB ingestion who refused hospitalization were excluded from the study. Demographic details, clinical manifestations, treatment methods, postoperative hospital stay lengths, postoperative complications, and patient outcomes were collected. Patients were divided into two groups: the conservative group (n=62) and the surgical treatment group (n=98). The surgical treatment group was further divided into laparoscopic (n=51) and laparotomy (n=47) subgroups.

Clinical decision criteria

The indications for conservative treatment were as follows: inability to remove or completely remove foreign bodies by gastroscopy, asymptomatic patients, and continued migration of foreign bodies, including hospital observation until excretion via the anus.

The indications for laparoscopic surgery were as follows: asymptomatic children with imaging showing that multiple magnetic beads had remained in the same position for two consecutive days, or had shown positional changes but no excretion within 4–6 days, or symptomatic children (e.g., with abdominal pain, vomiting) without intestinal obstruction.

The indications for laparotomy were as follows: severe abdominal distension, intestinal obstruction, or failure of laparoscopic surgery.

Proposed management algorithm

Based on these clinical decision criteria, we developed a management algorithm (Figure 1). The algorithm begins with abdominal X-ray localization, followed by endoscopic removal of gastroduodenal beads and expectant management with daily X-ray for asymptomatic cases below the duodenum. Surgical referral is indicated for symptomatic patients or those with non-progressive or retained beads beyond six days. When surgery is required, laparotomy is preferred when there is obvious intestinal obstruction; if obstruction is absent, laparoscopy is the initial approach, with conversion to laparotomy as needed.

Figure 1 Management algorithm for children with multiple magnetic foreign body ingestion. MMFB, multiple magnetic foreign body.

Statistical analysis

All statistical analyses were conducted using SPSS version 27.0. Categorical variables were presented as frequencies and percentages and were compared using Pearson’s Chi-squared test or Fisher’s exact test. Continuous variables were evaluated using the Mann-Whitney U test, and data were expressed as medians and interquartile ranges (IQRs). A two-tailed P value of less than 0.05 was considered statistically significant for all analyses.

To assess whether clinical practices and outcomes changed over the study period, we performed a time-trend analysis comparing the early period [2016–2020] and late period [2021–2025]. Unadjusted comparisons between the conservative and surgical groups were also performed.

To account for potential confounders, we performed multivariable logistic regression to identify independent predictors of surgical intervention, intestinal perforation, and prolonged hospitalization (≥10 days). Covariates included age, sex, number of magnetic beads, symptoms (abdominal pain, fever, and vomiting), elevated inflammatory markers [white blood cell counts (WBC) and C-reactive protein (CRP)], and clear ingestion history. The results are reported as odds ratios (ORs) with 95% confidence intervals (CIs); P<0.05 (two-tailed) was considered statistically significant.

Follow-up

Surgically treated patients were followed-up for 6–12 months after discharge to assess long-term outcomes, including readmission and late complications.

Results

Number of Patients with MMFB ingestion treated at CHZU from 2016 to 2025

During the 10 years, 160 patients with MMFB ingestion were included in the study (113 males and 47 females). Since the first case reported in 2016, the number of patients presenting to CHZU with MMFB ingestion has steadily increased, peaking in 2020. Notably, more than 10 cases have been recorded annually over the past 3 years (Figure 2).

Figure 2 Number of patients with MMFB ingestion treated at CHZU from 2016 to 2025. CHZU, Children’s Hospital of Zhejiang University School of Medicine; MMFB, multiple magnetic foreign body.

Time-trend analysis

When we compared the early [2016–2020] and late [2021–2025] periods (Table 1), several changes were observed. Surgery became less common (77.9% → 41.9%, P<0.001), overall endoscopy use increased (14.0% → 25.7%, P=0.10), and endoscopy as a definitive treatment and conservative management increased significantly (3.5% vs. 14.9%, P=0.02; 18.6% vs. 43.2%, P=0.001). Despite these shifts in practice, the complication rates remained stable (4.7% vs. 4.1%, P>0.99), the perforation rates fell substantially (72.1% → 40.5%, P<0.001), and the median hospital stay shortened from 10 days (IQR 7–13 days) to 4.5 days (IQR 2–11 days) (P<0.001).

Patients who received conservative treatment: outcomes

Among the 62 patients (38.8%) who received conservative treatment, 40 were male, and 22 were female. The median age was 62.5 months (IQR: 44.2–90.8 months), and the median weight was 18.6 kg (IQR: 15.4–25.9 kg). Notably, 59 patients had documented histories of suspected foreign body ingestion. WBC and CRP levels were within normal limits in these patients; only six patients presented with symptoms, mainly abdominal pain and vomiting. Among the 62 (38.8%) patients who received conservative treatment, foreign bodies were passed spontaneously through the anus in 50 cases, removed by gastroscopy in 8 patients, and extracted by colonoscopy in 1 patient. In three patients, the foreign bodies were partially removed under gastroscopy, with the residual portions passing spontaneously. Among the 50 patients who passed the foreign bodies spontaneously, daily abdominal X-ray examination showed progressive changes in their location over time, and all foreign bodies ultimately passed through the anus without any intervention. A total of 17 of these patients told their doctors that the foreign bodies had been swallowed at once. All patients recovered well, except for one case of gastric perforation (Table 2).

Patients who received surgical treatment: outcomes

There were 98 (61.2%) patients (73 males and 25 females) in the surgical treatment group, with a median age of 43.5 months (IQR: 25–67.8 months), which was significantly lower than that of the conservative treatment group (median age 62.5 months, IQR: 44.2–90.8 months; P<0.001). The median weight of the children in this group was 16 kg (IQR: 13–20.9 kg), also showing a statistically significant difference compared with the conservative treatment group (median weight 18.6 kg, IQR: 15.4–25.9 kg; P<0.001). A markedly high incidence of gastrointestinal perforation was observed in the surgical group (92.9%, 91/98). The small intestine was the most common site of magnet adhesion, with perforation repair being the primary surgical procedure. When repair was not feasible, an intestinal resection with anastomosis was performed. Furthermore, significant differences were observed between the two groups across multiple parameters, including the number of ingested magnetic beads, length of hospital stay, and symptom incidence. The surgical group had a median of seven beads (IQR: 4–12), which was significantly higher than the three beads (IQR: 2–6) observed in the conservative group (P<0.001). The length of hospital stay differed significantly between the surgical and conservative groups [11.5 days (IQR: 10–13 days) vs. 2 days (IQR: 1–3 days); P<0.001]. The symptom incidence rate was 65.3% (64/98) in the surgical group, which was statistically significantly higher than the 9.7% (6/62) observed in the conservative group (P<0.001). Abdominal pain and vomiting were the most frequently observed symptoms, and fever was noted in six cases. In addition, elevations in white blood cells and CRP levels were observed in some patients (Table 2).

The conservative and surgical groups differed significantly in baseline characteristics including age, number of magnetic beads, and symptom prevalence (Table 2). The comparisons presented above are unadjusted. The results of multivariable analyses adjusted for potential confounders are presented in the Results section.

In the surgical group, 52.0% (51/98) of patients underwent laparoscopic surgery; 6 patients required conversion to laparotomy, and overall, 56.8% (29/51) required conversion to laparotomy. An additional six patients required conversion to laparotomy from the laparoscopic group, bringing the total conversion figure to 29. The median number of magnetic beads ingested was seven (IQR: 3–12.5), and the median length of hospital stay was 11 days (IQR: 9–13.5 days). In the laparoscopic surgery subgroup, the affected bowel was exteriorized through an enlarged umbilical incision, after which foreign body removal and repair were performed. Therefore, these patients experienced less trauma and a more rapid recovery compared with those in the laparotomy group (Figure 3). Conversion from laparoscopy to laparotomy occurred in 29 children, primarily due to obvious abdominal distension or difficulty in exteriorizing the affected bowel through the umbilical incision. A total of 48.0% (47/98) of patients in the surgical group underwent primary laparotomy, of whom four underwent prior gastroscopy. The median number of magnetic beads ingested was eight (IQR: 5–12), and the median length of hospital stay was 12 days (IQR: 10–13 days). Among the 98 surgically treated patients, complications other than perforation included one case of postoperative intra-abdominal residual infection, two cases of postoperative intestinal obstruction, and two cases of incisional infection. All complications resolved with conservative management. Two patients (2.0%) were readmitted approximately 1 month after discharge because of intestinal obstruction; one was managed conservatively, and the other underwent adhesiolysis, with both recovering uneventfully. No other cases of readmission were observed. No long-term sequelae were identified during the follow-up (6–12 months). All of the other surgically treated patients recovered uneventfully (Table 3).

Figure 3 Patient 4, an 11-year-and-10-month-old boy with pica, presented with abdominal pain. During laparoscopic surgery, foreign bodies were found in the small intestine and had caused injury due to mutual attraction. (A) Radiography revealed multiple dense shadows in the pelvic region. (B-D) Laparoscopic surgery identified adhesions between small intestinal loops. After adhesiolysis, a perforation was found in the small intestine, from which the foreign bodies were removed. Subsequently, the necrotic intestinal segment was resected, followed by an intestinal anastomosis procedure. (E) The foreign bodies included magnetic beads, a button battery, and a paper clip.

Independent predictors of clinical outcomes

Multivariable logistic regression analyses were performed to identify independent predictors of surgical intervention, intestinal perforation, and prolonged hospitalization (≥10 days), with the results summarized in Table 4. Vomiting (OR =8.79, 95% CI: 1.85–66.62, P=0.01) and abdominal pain (OR =5.10, 95% CI: 1.33–21.36, P=0.02) were independent predictors of surgical intervention, as were number of magnetic beads (OR =1.06 per bead, 95% CI: 1.01–1.12, P=0.04), male sex (OR =3.56, 95% CI: 1.32–10.70, P=0.02), younger age (OR =0.98 per month, 95% CI: 0.97–1.00, P=0.03), and absence of clear ingestion history (OR =0.16, 95% CI: 0.03–0.67, P=0.02). For intestinal perforation, independent predictors were vomiting (OR =13.67, 95% CI: 3.07–100.02, P=0.002), abdominal pain (OR =3.88, 95% CI: 1.04–15.09, P=0.04), and number of beads (OR =1.06 per bead, 95% CI: 1.02–1.13, P=0.02). Prolonged hospitalization was not independently associated with any of the examined variables (all P>0.05)

Discussion

MMFBs can cause severe damage to the gastrointestinal tract of children. Through a retrospective analysis of 160 pediatric cases of MMFB ingestion, this study found that, since the first case was reported in 2016, the number of MMFB ingestion cases at CHZU has shown a continuously increasing trend, peaking in 2020. Notably, more than 10 cases have been recorded annually over the past three years (Figure 2). The incidence of accidental MMFB ingestion in children has increased in recent years (3,6,7), which aligns with our research findings. Our time-trend analysis showed that the clinical practice for MMFB ingestion changed significantly over the 10-year study period. Comparing the early [2016–2020] and late [2021–2025] periods, we found a clear shift away from primary surgery (77.9% → 41.9%, P<0.001) toward more conservative management (18.6% → 43.2%, P=0.001) and more frequent use of endoscopy—both as a general diagnostic/therapeutic tool (14.0% → 25.7%, P=0.10) and as definitive treatment (3.5% → 14.9%, P=0.02). Importantly, these changes in practice were not associated with poorer outcomes. Instead, complication rates remained stable (4.7% vs. 4.1%, P>0.99), perforation rates dropped substantially (72.1% → 40.5%, P<0.001), and median hospital stay fell from 10 days to 4.5 days (P<0.001).

Several factors likely contributed to this temporal shift, including growing awareness of MMFB ingestion risks among pediatricians and emergency physicians (3), increasing institutional experience with endoscopic retrieval (8,9), and an increasing number of reports showing that conservative or endoscopic management is feasible for selected patients (10,11). These findings have practical implications. First, they suggest that the move toward less invasive management is safe and potentially beneficial; second, that pooling data across the entire 10-year period is unlikely to bias our main conclusions; and third, that endoscopic and conservative strategies should continue to be promoted in appropriately selected children.

We acknowledge that prior studies have established associations between higher magnet counts and surgical intervention, the elevated risk of gastrointestinal perforation, and a basic algorithm for conservative versus surgical management (5,12). However, this study is not the first to reveal this relationship. Nevertheless, this study offers several useful contributions to the literature. First, to the best of our knowledge, this study is one of the largest single-center cohorts of pediatric multiple magnet ingestion to date. Second, we report a laparoscopic-to-open conversion rate of 56.8% and describe the specific anatomical reasons for conversion, a detail previously absent from other series. Third, we include a rare case of pica involving a mixture of foreign bodies (magnets, a button battery, and a paper clip). Finally, our 10-year trend data show that cases peaked in 2020 and have remained above 10 per year since then, information that may inform local prevention efforts. In summary, while this study largely reinforces existing evidence, it adds granular real-world data from a high-volume center.

Among the 62 (38.8%) patients who received conservative treatment, daily abdominal radiographs performed in 50 patients revealed progressive changes in the position of the foreign bodies over time, which were ultimately passed through the anus. The median hospital stay in this group was 2 days (IQR: 1–3 days). In contrast to our findings, previous studies have shown that MMFBs typically resolve spontaneously after 4–6 days of conservative treatment (4,8). Endoscopic removal was performed in 12 patients; complete removal of the MMFBs was achieved through gastroscopy in eight patients and through colonoscopy in one patient; and the MMFBs were partially removed by gastroscopy, with the remaining portions excreted spontaneously in three patients. Therefore, if the patient is asymptomatic, with either a single magnetic foreign body or MMFBs ingested at one time, conservative treatment may be considered appropriate (9-11). Daily abdominal X-ray examination should be conducted until the foreign body is expelled through the anus. If the X-ray examination reveals magnetic beads in the left upper quadrant, emergency gastroscopy is necessary. Dutch guidelines and those of the European and North American societies for pediatric gastroenterology recommend that, when multiple magnets are ingested and located in the esophagus or stomach, endoscopic removal should be performed within 24 hours (13).

However, if symptoms such as abdominal pain and vomiting occur in children or if repeated radiographs show magnetic foreign bodies in the same position, surgical intervention should be considered (14,15). In this study, the incidence of gastrointestinal perforation in the surgical group was 92.9% (91/98), and the incidence of symptom was 65.3% (64/98). These figures are consistent with the 88–96% perforation rates reported by Kim et al. and Chen et al. (14,16). Notably, an earlier multicenter series reported perforation rates reaching 100% in its surgical cohort (17). Collectively, these data demonstrate that the vast majority (>90%) of children requiring surgery for MMFB ingestion have already developed intestinal perforation. Therefore, the onset of clinical symptoms, particularly abdominal pain and vomiting, should be regarded as a critical warning sign, and prompt surgical intervention should be strongly considered to prevent further deterioration, rather than pursuing prolonged observation or conservative management (18,19).

Several factors contribute to this high perforation rate. First, CHZU is a national regional children’s hospital that admits children with severe conditions and complex cases referred who are from other hospitals. Furthermore, unlike other types of gastrointestinal foreign bodies, when multiple magnetic beads are ingested simultaneously or at different times, they tend to adhere to one another across different intestinal segments, resulting in serious complications including bowel necrosis and perforation (20).

In this study, 29 of the 51 patients (56.8%) in the laparoscopic group were converted to open surgery. This rate falls within the 42.9–63.6% range reported in recent studies on multiple magnet ingestion (16,19). The high conversion rate was mainly attributed to the magnetic foreign bodies attracting each other across multiple segments of the digestive tract. Exteriorizing the affected bowel through the umbilical incision was challenging when magnets were located in the duodenum or colon. Forcible removal during laparoscopy may lead to peritoneal contamination, retained beads, or missed microperforations, resulting in serious postoperative complications (18). Therefore, a thorough preoperative assessment is essential, and the decision for open surgery should be made decisively in critically ill patients or those with significant abdominal distension, balancing the benefits of minimally invasive techniques against the complexity of the condition. This finding supports the cautious approach advocated by Hayward and Saxena, who suggested a low threshold for conversion in complex cases (21).

Our study found that the surgical group had a median of seven beads (IQR: 4–12), which was significantly higher than the three beads (IQR: 2–6) observed in the conservative group (P<0.001). This finding is in agreement with those of earlier studies showing that a higher number of ingested magnets is strongly associated with surgical intervention (22,23). The underlying mechanism is that multiple beads attract each other across separate intestinal loops, leading to wall compression, ischemia, necrosis, and perforation (3,14). A practical takeaway from our data is that a threshold of four or more magnets predicts surgery; this represents a simple clinical rule that adds to the existing literature, which has largely focused on continuous risk associations. Patients in the surgical group were significantly younger and weighed less than those in the conservative group, indicating that younger and lower-weight children were more likely to undergo surgery. Due to their limited ability to provide accurate medical histories, diagnoses, and treatments, delays in these services are frequently seen in this population. Therefore, closer observation and more proactive management of MMFB ingestion in young children are required. When MMFB ingestion is suspected or confirmed, an abdominal radiograph should be promptly obtained to accurately count the number of beads and dynamically monitor their positional changes (23).

Of particular note was a case involving an 11-year-11-month-old patient with pica who had ingested multiple foreign bodies, including magnetic beads, a button battery, and a paper clip, resulting in small bowel necrosis and intestinal perforation. The patient successfully underwent laparoscopic surgery with foreign body extraction, resection of the necrotic intestinal segment, and primary anastomosis (Figure 3). The current literature indicates that pica often correlates with psychological factors (24), suggesting that surgical intervention, while necessary for physical removal, represents only one component of comprehensive management. Postoperative management that addresses the underlying etiology and psychological factors is equally crucial (25).

In addition to these descriptive findings, our multivariable analysis provided quantitative risk estimates. Among the independent predictors identified, vomiting emerged as the strongest clinical marker, with adjusted ORs of 8.79 for surgery and 13.67 for perforation, substantially higher than the OR of 3.30 reported by Romano et al. in a large multicenter study (26). Abdominal pain also independently predicted both outcomes (OR: 5.10 for surgery, OR: 3.88 for perforation), consistent with the nomogram by Luo et al., which identified these as key predictors (27). Male sex (OR: 3.56) and younger age (OR: 0.98 per month) were associated with surgery but not with perforation or prolonged hospitalization. Interestingly, a clear ingestion history was strongly protective against surgery (OR: 0.16); patients with a known ingestion time were less likely to require surgery because an earlier presentation enabled endoscopic removal before complications developed. This aligns with the finding of Khader et al., who reported that diagnostic delay is a major risk factor for adverse outcome (28). Taken together, vomiting and abdominal pain are the key symptoms, and the number of magnetic beads (OR: 1.06 for both outcomes) offers additional objective support for risk stratification.

Beyond the primary outcomes of perforation and hospital stay, our findings on complications, readmissions, and long-term sequelae further support the safety and feasibility of surgical intervention in children with MMFB ingestion (21). Specifically, postoperative complications occurred in only five of the 98 surgically treated patients (5.1%), and all were successfully managed conservatively without the need for additional surgical procedures. This indicates that complications are typically self-limiting or easily controlled. Moreover, the readmission rate was low (2.0%), and only one patient required repeat surgery (adhesiolysis) for intestinal obstruction, whereas the other patient was managed conservatively, suggesting that the surgery-related long-term morbidity is minimal (17). Most importantly, the absence of any long-term sequelae during follow-up (6–12 months) provides reassurance to both clinicians and families that surgical intervention does not compromise children’s long-term recovery or quality of life. Collectively, these outcome data enhance the clinical relevance of our study by demonstrating that surgical treatment not only addresses the acute injury caused by magnetic foreign bodies, but also carries an acceptably low risk of subsequent adverse events.

Several limitations should be acknowledged. First, this was a retrospective, single-center study, and treatment allocation was not randomized. As shown in Table 2, the conservative and surgical groups differed substantially in baseline characteristics, including age, number of magnets, and symptom frequency. These differences are expected in observational studies and reflect clinical decision-making rather than a design flaw. Second, to address confounding, we performed multivariable logistic regression adjusting for prespecified confounders (Table 4). However, residual confounding due to unmeasured variables, such as the time from ingestion to presentation or socioeconomic status cannot be excluded. Third, detection bias may have influenced the diagnosis of perforation, as asymptomatic patients were less likely to undergo surgery or intensive imaging. Additionally, together with the retrospective design of the study, the very high perforation rate (92.9%) in the surgical group may have introduced a selection bias; that is, children with more severe conditions, those who already had perforation, or those with a high suspicion of perforation were more likely to be assigned to the surgical group due to physician experience. Despite these limitations, the large sample size and the consistency between the unadjusted and adjusted findings support the robustness of our conclusions. Finally, this study is a single-center study, with all cases derived from the same medical institution, which may limit the external validity of the results. Future research should aim to expand the scope of the investigation through larger multicenter prospective studies to provide more reliable guidance.

We also recognize that the main clinical messages of this study, including that more magnets are associated with a higher surgical risk and rate of perforation, have been well demonstrated in earlier publications. Thus, we do not claim to have made any fundamentally discovery. Instead, our primary contribution is to provide a large, up-to-date, single-center experience that confirms these known associations and adds practical details about surgical decision-making (especially the high laparoscopy conversion rate) and long-term trends. Therefore, readers should interpret our findings alongside existing literature.

Conclusions

In conclusion, the ingestion of MMFBs can result in severe injuries in children. In clinical management, strengthening preoperative evaluation and developing individualized treatment plans tailored to the specific condition of the child are crucial for improving prognosis. Gastroscopy plays a key role in the management of this condition, and timely surgical intervention, when necessary, is essential to prevent serious complications. Indeed, prevention is often more effective than treatment. Therefore, governments should be encouraged to strengthen public awareness, discourage the use of magnetic toys, and mandate effective warning labels. Parents should be alerted to these risks, and children must be kept away from such products.

Acknowledgments

The authors are grateful to the patients and their families for their contribution and their consent for the publication of this study.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0216/rc

Data Sharing Statement: Available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0216/dss

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0216/prf

Funding: This work was supported by the following grants: National Key Research and Development Program of China (No. 2024YFC2707005); the Science and Technology Department of the State Administration of Traditional Chinese Medicine (No. GZY-ZJ-KJ-24085); National Natural Science Foundation of China (No. 82202359); and the Special Fund for the Incubation of Young Clinical Scientist, Children’s Hospital of Zhejiang University School of Medicine (No. CHZJU2023YS002).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0216/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was approved by the Ethics Committee of Children’s Hospital, Zhejiang University School of Medicine (approval No. 2025-IRB-0422-P-01). Informed consent was obtained from all patients’ legal guardian prior to inclusion. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Alansari AN, Baykuziyev T, Soyer T, et al. Magnet ingestion in growing children: a multi-center observational study on single and multiple magnet incidents. Sci Rep 2024;14:4575. [Crossref] [PubMed]
2. Li XL, Zhang QM, Lu SY, et al. Accidental ingestion of multiple magnetic beads by children and their impact on the gastrointestinal tract: a single-center study. BMC Pediatr 2024;24:5. [Crossref] [PubMed]
3. Nugud AA, Tzivinikos C, Assa A, et al. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. J Pediatr Gastroenterol Nutr 2023;76:523-32. [Crossref] [PubMed]
4. Baindur AJ, Gupta PK, Khare AK. Magnetic beads masquerading as a bracelet causing ileal volvulus with multiple ileoileal fistulae in a child: A case report with systematic literature review. Trop Doct 2025;55:155-60. [Crossref] [PubMed]
5. Chang A, Yeap E, Lee E, et al. Decade of the dangers of multiple magnet ingestion in children: A retrospective review. J Paediatr Child Health 2022;58:873-9. [Crossref] [PubMed]
6. Lai X, Luo Y, Teng S, et al. Prediction of complications from pediatric multiple magnet ingestion: development and validation of radiologic and clinical-radiologic nomograms in a large retrospective study. BMC Pediatr 2025;25:932. [Crossref] [PubMed]
7. Petersen JR, Vogt JS. Endoscopy-assisted magnetic foreign body removal using a magnetic instrument-a clinical review. Surg Endosc 2025;39:4102-8. [Crossref] [PubMed]
8. Torrico JC, Gregorio GEV. Flexible Endoscopic Management of Foreign Body Ingestion in Children: A Ten-Year Single-Center Retrospective Study in the Philippines. Acta Med Philipp 2026;60:45-56. [Crossref] [PubMed]
9. Lei H, Yang J, Bian H, et al. Superabsorbent polymer beads ingestion by children: a single-center retrospective study of 11 cases. BMC Pediatr 2026;26:234. [Crossref] [PubMed]
10. Jin Y, Gao Z, Zhang Y, et al. Management of multiple magnetic foreign body ingestion in pediatric patients. BMC Pediatr 2022;22:448. [Crossref] [PubMed]
11. Kwon HJ, Park J. Surgical removal of ingested magnets in children: A retrospective clinical analysis of 16 patients and review of the literature. Medicine (Baltimore) 2025;104:e42903. [Crossref] [PubMed]
12. Pereira LDM, Barreira MA. Endoscopic techniques and factors for complications in pediatric esophageal foreign body removal. World J Gastrointest Endosc 2025;17:106352. [Crossref] [PubMed]
13. van Waas M, De Bruyne P, de Ridder L. Paediatric multiple magnet ingestion. Lancet Gastroenterol Hepatol 2021;6:80. [Crossref] [PubMed]
14. Kim H, Kang A, Kim SH, et al. Is surgery always necessary for multiple magnet ingestion in children?-evidence for an endoscopy-first approach. Transl Pediatr 2026;15:16. [Crossref] [PubMed]
15. Varlıklı O, Akay MA, Gürbüz Sarıkaş N, et al. The danger of magnet attraction: an 11-year cohort of pediatric intestinal complications due to magnet ingestion. Turk J Pediatr 2025;67:720-31. [Crossref] [PubMed]
16. Chen Y, Chen Q, Qian Y, et al. Individualized Treatment of Multiple Magnetic Foreign Body Ingestion in Children. J Laparoendosc Adv Surg Tech A 2025;35:94-100. [Crossref] [PubMed]
17. Ding G, Liu H, Zhou P, et al. Pediatric Multiple High-Powered Magnetic Buckyballs Ingestion-Experience From Six Tertiary Medical Centers. Front Public Health 2022;10:892756. [Crossref] [PubMed]
18. Yeon HJ, Lee SM, Ihn K, et al. Pediatric Foreign Body Ingestion: Analysis of Patient Characteristics and Surgical Treatment. Children (Basel) 2025;12:1355. [Crossref] [PubMed]
19. Nezhentsev A, Neville JJ, Hall NJ. Diagnosis and management of paediatric magnet ingestion: a systematic review of clinical practice guidelines. Emerg Med J 2026;43:167-73. [Crossref] [PubMed]
20. Areed MA, Elawdy M, Albalushi A, et al. Multiple Magnet Ingestion in a Child With an Overlooked Diagnosis Leading to Intestinal Perforation. Cureus 2026;18:e104994. [Crossref] [PubMed]
21. Hayward RK, Saxena AK. Surgical management of pediatric multiple magnet ingestions in the past two decades of minimal access surgery- systematic review of operative approaches. Updates Surg 2024;76:1203-11. [Crossref] [PubMed]
22. Neville JJ, Lyttle MD, Messahel S, et al. Magnet ingestion in children in the United Kingdom: a national prospective observational surveillance study. Arch Dis Child 2025;110:778-85. [Crossref] [PubMed]
23. Quitadamo P, Gragnaniello P, Isoldi S, et al. Magnetic foreign body ingestion in pediatric age. Dig Liver Dis 2024;56:1002-6. [Crossref] [PubMed]
24. Rubino LG, Bulik CM, Chawner SJRA, et al. Pica in Childhood: Concurrent and Sequential Psychiatric Comorbidity. Int J Eat Disord 2025;58:1936-45. [Crossref] [PubMed]
25. Öztürk B, Güngör A, Yoldaþ TÇ, et al. Social, Emotional and Behavioral Problems in Children With Foreign Body Ingestion: A Case Control Study. Indian Pediatr 2024;61:447-51.
26. Mantegazza C, Ferraro S, Biganzoli D, et al. Foreign body ingestion in children: Definition of a nomogram to predict surgical or endoscopic intervention. Dig Liver Dis 2024;56:312-21. [Crossref] [PubMed]
27. Luo Y, Cui X, Zhou J, et al. Development and Validation of a Clinical Nomogram for Predicting Complications From Pediatric Multiple Magnet Ingestion: A Large Retrospective Study. Am J Gastroenterol 2025;120:642-9. [Crossref] [PubMed]
28. Khader J, De Loizaga E, Johns A, et al. Paediatric magnet ingestion persists worldwide despite increasing regulatory policies. Inj Prev 2025;31:465-77. [Crossref] [PubMed]