A 2-year-old boy is transferred from another hospital with these abdominal x-rays (AXRs) (taken 4 hours ago):

 

 

[size=20px]He is well appearing, and his abdomen is slightly distended with mild tenderness. The father thinks that he swallowed a screw.

 

What is the best next step in management?

 

A Place NGT and make NPO

 

B Administer miralax

 

C Discharge home

 

D Repeat abdominal x-rays[/size]

D

I would admit him because of the tenderness and repeat xrays the next day

D

D

D as he is symptomatic, I would repeat the x ray and observe him in hospital

D

c

Correct answer

D Repeat abdominal x-rays

 

Given the patient’s history, the initial AXR reading was consistent with a screw. Repeat imaging was obtained and is shown below: However, the repeat AXRs are concerning in that the foreign body did not move during the four-hour interval from the initial AXRs. Furthermore, the foreign body now appears to be small magnets given the slight gap at the end of the foreign body along with the malalignment of the objects. The patient was taken for diagnostic laparoscopy and found to have multiple enterotomies from the magnets. The operation was converted to laparotomy and the magnets retrieved and the enterotomies repaired.