Abstract: Objective? To explore the clinical characteristics and prognosis of multiple magnetic foreign bodies in the gastrointestinal tract in children. Methods? Clinical data of 31 patients who swallowed multiple magnets and received endoscopic management and/or surgery in Henan Children’s Hospital from January 2014 to July 2020 were retrospectively analyzed. Results? The enrolled patients included 23 boys and 8 girls with the median age of 34 months. Patients yoanger than 3 years old accounted for 58.1% (n=18 ). The duration from ingestion to hospital visit ranged from 5 h to 60 d. The median number of magnets was 5 with a range from 2 to 24 . The common type of foreign bodies was Bucky ball magnet (n= 27 , 87 . 1%). There are 27 children suffered from multiple gastrointestinal perforations (range: 2 - 8 ), and 4 children (n = 4 , 12 . 9%) had no digestive duct injury. The majority of perforation was located at the small intestine ( 17/ 27 , 63 . 0%), including simple small intestinal perforation ( 12/ 27 , 44 . 4%), followed by gastric perforation and esophagus-gastric perforation ( 5/ 27 , 18 . 5%). The most common presenting signs and symptoms in children with perforation were abdominal pain (n= 14 , 51 . 9%) , vomiting (n= 11 , 40 . 7%), fever (n = 5 , 18 . 5%), and bloating (n= 4 , 14 . 8%). However, six patients ( 6/ 27 , 22 . 2%) had no clinical symptoms. Endoscopic foredgn body extraction was successful in 32.3% (n=10) of cases; while surgery was required in 21 patients (67.7%), including 9 cases failed endoscopic treatment. All patients with gastrointestinal perforation were fully recovered, including 6 cases ( 6/ 27 , 22 . 2%) treated with indwelling gastrointestinal decompression tube and enteral nutrition via nasojejunal tube, another 21 cases ( 21/ 27 , 77 . 8%) underwent surgical repair. One patient had intestinal obstruction and underwent a second operation, and the remaining patients’ courses were uneventful during the follow-up period. Conclusion The ingestion of multiple magnets is harmful for children’s health because of its severe digestive tract injury, such as perforation. Early diagnosis and treatment are important. The combination of endoscopy and surgery is necessary. If magnetic foreign bodies cannot be removed by endoscopy, surgical intervention is suggested as soon as possible to avoid serious complications.

Key words: ? gastrointestinal tract;? child;? multiple magnetic foreign bodies;? perforation