Combined Laparoscopic and Colonoscopic Retrieval of Multiple Ingested Magnetic Beads Without Enterotomy in Children: A Case Report and Literature Review.

BACKGROUND: Magnetic foreign body ingestion is one of the high-risk accidental injuries in pediatric emergency medicine. Especially when multiple magnets are swallowed, they can attract each other rapidly and cause sustained compression of the intervening intestinal walls, which may lead to necrosis and perforation. This report presents a successful pediatric case of retrieving multiple magnetic beads from the ileum using laparoscopy combined with colonoscopy without enterotomy, aiming to provide practical insights for individualized, organ-preserving management of these patients. CASE PRESENTATION: A 4-year and 11-month-old boy presented to the emergency department approximately 1 hour after ingesting four high-powered magnetic beads. Initial emergency upper gastrointestinal endoscopy revealed no foreign body in the esophagus, stomach, or duodenum. Conservative management was initiated with close clinical and radiographic monitoring. Serial abdominal radiographs over three consecutive days demonstrated persistent localization of the magnetic beads in the right lower abdomen without migration. To avoid the risks such as prolonged intestinal compression and subsequent necrosis, we performed an emergency laparoscopic exploration. Intraoperatively, the intestinal tract was examined and gently manipulated to ensure the magnetic beads passed smoothly through the ileocecal valve as a whole, allowing complete removal through colonoscopy. Oral intake of fluids was resumed on postoperative day 1, and the child was discharged on postoperative day 3 without any complications. CONCLUSION: Multiple magnetic foreign bodies retained in proximity to the ileocecal valve without intestinal wall compression or necrosis may be suitable candidates for combined laparoscopic and endoscopic retrieval without enterotomy, thereby optimizing intestinal preservation and facilitating patient recovery.