Wound Complications Resulting From Magnet Ingestion in a Toddler

G is a 2 year old boy who ingested high powered magnets causing perforations in his cecum and distal ileum. The patient was critically ill and developed multiple fistulae over a 5 month hospitalization. Managing the abdominal wound and fistulae was challenging. Ultimately a simple plan provided the best solution to allow this toddler to maintain his age appropriate activities and reduce negative consequences of prolonged hospitalization. 

Initially G was managed using NPWT. Fistulae developed under the tissue matrix graft, effluent pooled and NPWT was no longer effective. The patient was transitioned to a fistula pouch connected to suction. Pouch changes were traumatic and conscious sedation was required with each change. The skin became irritated due to multiple pouch changes. The need for continuous suction and conscious sedation limited the child’s activity and ability to engage in normal toddler play.

To minimize pain and anxiety, the following treatment plan was devised:

1. Antifungal powder, no-sting barrier, and Zinc-oxide based hydrophilic paste applied to periwound skin
2. Fistulae were covered with gauze sponges, diaper (opened) and placed over wound, secured with stretch net or ace wrap.
3. Gauze/diaper changed as needed
4. Hydrophilic paste reapplied 2 to 3 times per day.

Conscious sedation and pain medication was no longer needed. G tolerated dressing changes well. The skin improved significantly and remained intact. The new treatment protocol allowed the patient to ambulate, play, and tub bathe. G was able to be a toddler again. He transitioned to home with mom providing his care.

Reducing negative consequences associated with prolonged hospitalization was paramount in determining care. It was important to allow this toddler to be active and continue to evolve in his developmental milestones. By simplifying the treatment mom was able to provide care at home.