Mis-swallowing of Buckyballs, an overlooked threat to our children

With the continuous thriving of online shopping industries, promotions of various products have become more overwhelming to everyone, including teenagers and children. Hundreds of small rare-earth magnets, the so-called Buckyballs, are sold as table toys and are promoted as being able to enhance intelligence and innovation, as well as relieve stress; however, no risks or warnings about “the other side of the coin” have been mentioned. In 2009, Buckyballs were first introduced as toys. Thereafter, increasing cases of mis-swallowing of these brightly-colored magnets in pediatric population were reported to cause serious gastrointestinal injury or death in extreme cases.1De Roo A.C. Thompson M.C. Chounthirath T. Xiang H. Cowles N.A. Shmuylovskaya L. et al.Rare-earth magnet ingestion-related injuries among children, 2000-2012.Clin Pediatr (Phila). 2013; 52: 1006-1013Crossref PubMed Scopus (25) Google Scholar,2Hodges N.L. Denny S.A. Smith G.A. Rare-earth magnet ingestion-related injuries in the pediatric population: a review.Am J Lifestyle Med. 2015; 11: 259-263Crossref PubMed Scopus (10) Google Scholar The U.S. Consumer Product Safety Commission actively lobbied medical associations, consumer associations, the press and health agencies outside the U.S. to ban all loose high-powered magnets from being sold. Although such products are back on the market after a period of ban in the U.S., warning labels and age restrictions have become mandatory. Some other countries have prohibited the sale of Buckyballs.3Product Safety AustraliaSmall, high powered magnets banned.https://www.productsafety.gov.au/news/small-high-powered-magnets-bannedGoogle Scholar,4Government of Canada Information for manufacturers, importers, distributors and retailers of products containing small, powerful magnets. Date modified: 2013-08-07.https://www.canada.ca/en/health-canada/services/consumer-product-safety/advisories-warnings-recalls/letters-notices-information-industry/information-manufacturers-importers-distributors-retailers-products-containing-small-powerful-magnets.htmlGoogle Scholar A twelve-year-old boy was presented 1 h after mis-swallowing Buckyballs after a big dinner. X-ray revealed a chain of nine radio-opaque pellets in his abdomen (Fig. 1A). Given that his stomach was full and that he was asymptomatic, emergent endoscopy was withheld after shared decision making with his parents. X-ray in the next morning revealed these Buckyballs in a ring (Fig. 1B). Gastroendoscopy failed to remove them because the Buckyballs had moved pass the second portion of the duodenum. He remained asymptomatic and the Buckyballs continuously showed signs of movement on every follow-up X-ray (Fig. 1C, D). No foreign body was found on by X-ray two days after the ingestion (Fig. 1E). In cases of magnets ingestion, pressure necrosis will occur if any part of the gastrointestinal tract is entrapped between magnets or a magnet and another co-ingested ferromagnetic object. Early diagnosis is difficult because symptoms and signs vary from asymptomatic, nausea, vomiting, and abdominal pain to features that suggest bowel obstruction or peritonitis. Although the history of magnet ingestion is suggestive, such incidents are frequently not witnessed and teenagers may withhold information about the ingestion.1De Roo A.C. Thompson M.C. Chounthirath T. Xiang H. Cowles N.A. Shmuylovskaya L. et al.Rare-earth magnet ingestion-related injuries among children, 2000-2012.Clin Pediatr (Phila). 2013; 52: 1006-1013Crossref PubMed Scopus (25) Google Scholar,2Hodges N.L. Denny S.A. Smith G.A. Rare-earth magnet ingestion-related injuries in the pediatric population: a review.Am J Lifestyle Med. 2015; 11: 259-263Crossref PubMed Scopus (10) Google Scholar Consequently, delays in diagnosis can increase the likelihood of complications such as bowel perforation, peritonitis, volvulus, enteric fistula, or even death. In a study by De Roo et al.,1De Roo A.C. Thompson M.C. Chounthirath T. Xiang H. Cowles N.A. Shmuylovskaya L. et al.Rare-earth magnet ingestion-related injuries among children, 2000-2012.Clin Pediatr (Phila). 2013; 52: 1006-1013Crossref PubMed Scopus (25) Google Scholar surgery was required in 69.7% of cases where treatment was reported. Therefore, endoscopic removal must be done as early as possible when ingested magnets are within reach. Prevention of rare-earth magnet ingestion is paramount, since serious injuries may occur in patients without timely recognition and intervention. Apart from warning labels, restriction of sale and advocacy to physician, parents, caregivers, and teenagers should be enforced, so as to create awareness about the unique risks posed by ingestion of magnets. As with the parents of our case, they clearly stated that they had known the risks in advance, and they would have not purchased the Buckyballs. None to be declared.

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