多次摄入磁铁导致慢性空肠结肠瘘和肠道吸收不良:病例报告和系统综述。

Rahşan Özcan, Ali Ekber Hakalmaz, Ayşe Kalyoncu Uçar, Omer Beser, Senol Emre
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摘要

儿童误食磁铁可导致严重的急性和慢性并发症。本病例报告讨论了一个涉及多次摄入磁铁的病例的治疗方法,该病例导致了空肠结肠瘘、节段性肠外翻、肝骨质增生和晚期发现的肾结石。此外,我们还进行了文献综述,以探讨误食磁铁导致肠瘘的特点。一名六岁女童因持续两年的间歇性腹痛、呕吐和腹泻而被送往儿科消化内科就诊。最初的鉴别诊断包括乳糜泻、囊性纤维化、炎症性肠病和结核病,但病因仍然难以确定。小儿外科团队根据磁共振成像结果,怀疑患者患有空肠结肠瘘。体格检查未发现急腹症体征,但有轻度腹胀。随后的上消化道造影和造影剂灌肠检查证实患儿患有空肠结肠瘘和节段性肠管外翻。家属后来报告说,孩子两年前曾吞下一块磁铁,磁铁在一到两周内自发排出后,医疗随访就停止了。必须进行手术治疗,以纠正空肠卷曲并修复巨大的空肠结肠瘘。为了确定相关研究,我们根据 PRISMA(系统综述和元分析首选报告项目)指南对磁铁摄入和胃肠道瘘进行了详细的文献检索。我们共发现 44 篇文章,涵盖 55 个病例,这些病例在急性期症状不明显,也未观察到急腹症。29 个病例的磁铁摄入时间不明。在已知摄入时间的 26 个病例中,发现瘘管的平均时间为 22.8 天(范围:1-90 天)。47例患者通过开腹手术进行了瘘管修补。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Chronic jejuno-colonic fistula and intestinal malabsorption due to multiple magnet ingestions: A case report and systematic review.

Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.

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