Question of the Week

For November 14, 2017

A 5-year-old girl is brought to the emergency department by her parents after she admitted to swallowing toy magnets at a friend’s house earlier that day. She had no symptoms at home.

Examination reveals a nondistended, nontender abdomen with active bowel sounds. A two-view radiograph of the abdomen shows two spherical foreign bodies traveling in close proximity to each other in the small bowel in the umbilical region of the abdomen with no signs of obstruction.

Serial radiographs, 6 and 12 hours later, reveal no interval progression of the magnets. The patient remains asymptomatic with normal vital signs and a normal physical examination.

Which one of the following next steps is most appropriate in this case?

Initiate a stimulant laxative
Perform a CT scan using oral contrast to better evaluate the positions of the magnets
Continue serial abdominal radiographs until the magnets are expelled or signs of obstruction develop
Arrange for surgical or endoscopic removal of the magnets
Discharge to home with a follow-up radiograph in 3 days to see if the magnets have passed