Single Magnet Ingestion- Individualizing the Algorithm.

We present a case that encouraged us to revisit the management algorithm in single magnet ingestion [1]. A child had undergone a double-barrel sigmoid colostomy for anorectal malformation during neonatal period, with a plan for staged surgical repair. At four years of age he presented to the surgeon after ingestion of a single small magnet. The magnet was visible in the epigastrium on radiography. Being asymptomatic, serial radiological follow-up was advised, but the parents did not report for follow-up. Five months later, the child presented with frequent colicky abdominal pain and bloating which used to subside with passage of stools. On examination, the abdomen was soft, and stoma was extremely tight allowing only the tip of the little finger resulting in oozing of blood. Anteroposterior radiograph revealed a magnet on the left side of the abdomen. A 9.2 mm esophagogastroduodenoscope was inserted through the stoma into the proximal loop with difficulty, and a 1.5 cm magnet was visualized proximal to the stoma. Attempts to remove it with rat-tooth forceps led to repeated slipping as the stoma was narrow. A net retrieval device was used, and the magnet could be removed only with significant force that damaged the net. There was selflimited oozing from the stoma. The child became asymptomatic after removal of the foreign body.