Enteroenteric Fistula: A Rare Sequela of Unwitnessed Magnet Ingestion in a Child

Enteroenteric fistula is an abnormal connection between two loops of bowel, commonly caused by chronic inflammatory disease, malignancy, history of a surgical procedure, radiation, or foreign body ingestion. A previously healthy three-year-old female presented to the Emergency Department in Al Jalila Children's Specialty Hospital, Dubai, UAE, with a one-day history of non-bilious vomiting and colicky abdominal pain. She had no history of fever, loose stools, or bloody stools. On examination, her abdomen was soft, mildly distended, and tender all over, with no palpable masses. She was admitted for one day, improved, and was discharged in good general condition. However, 72 hours later, she presented with the same complaint, and the X-ray of the abdomen showed signs of intestinal obstruction, which were confirmed by an abdominal CT scan. A laparoscopy was performed, showing a band extending from the mid-ileum to the cecum and an enteroenteric fistula between the terminal ileum and cecum. The band was divided, and a laparoscopic-assisted division of the fistula was performed and sutured. She was discharged four days postoperatively in good general condition. On further questioning, the parents mentioned having a missing magnet at home. This case highlights the serious risks of unnoticed magnet ingestion in children, emphasizing the importance of vigilance, prompt evaluation, and intervention to prevent complications, particularly in households with accessible small magnets. To our knowledge, this is the first reported case of an unwitnessed magnet ingestion, which was also not detected by imaging, causing an enteroenteric fistula and subsequently passing unnoticed.