Purpose or Case Report: The ingestions of magnetic foreign objects are a common occurrence in the pediatric population. The American Association of Poison Control has documented 95,700 incidents of foreign-body ingestion in the year 2011 alone with most cases occurring in children younger than 5 years of age. In this case, we present a two-year-old male who presented to the emergency department with a four-day history of bilious vomiting.
Methods & Materials: A variety of imaging modalities including ultrasound, plain films, and fluoroscopy to aid in diagnosis and management of our patient.
Results: An abdominal radiograph in the frontal and supine positions to evaluate for a small bowel obstruction demonstrated a small amount of small bowel and colonic gas present, but was without gas-filled dilated loops of bowel or radiopaque foreign object present. Subsequently, an abdominal ultrasound was performed for the evaluation of intussusception, which was also ruled out. Due to an increasing suspicion of malrotation, a fluoroscopic upper GI series was performed that raised concern of a proximal to mid-jejuno-jejunal fistula. A repeat abdominal radiograph post- oral contrast administration also showed dilatation of the small bowel without evidence of volvulus. With evidence of at least a partial small bowel obstruction, pediatric surgery proceeded with an exploratory laparotomy. Surgery confirmed the presence of a jejuno-jejunal fistula and a fibrous band around the distal jejunum causing a small bowel obstruction.
Conclusions: This case displays a unique presentation of a jejeno-jejunal fistula caused by small magnet ingestion. We demonstrate the importance of various imaging modalities in determining the etiology bilious vomiting outside of the classic presentations. There have been many cases of pediatric ingestion of magnetic objects; however, this case demonstrates a rare presentation of a jejuno-jejunal fistula that has only been previously documented in two other cases. Upon further questioning of the family after surgical intervention, they revealed that the patient likely swallowed a few small magnets weeks ago. Since the events in question had been weeks prior, the magnets were no longer visible on imaging and clinical suspicion was therefore initially low. The use of additional imaging modalities was vital in this case to ascertain the final diagnosis and management that prevented immediate morbidity and potential long-term gastrointestinal complications.