{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T02:00:06Z","timestamp":1783044006590,"version":"3.54.6"},"reference-count":78,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Entero-enteric fistula (EEF) formation following multiple magnet ingestion is a rare but severe complication among pediatric patients. The widespread availability of neodymium magnets in toys has increased incidence of ingestion and subsequent gastrointestinal injuries. This systematic review aims to summarize the clinical features, diagnostics, management and outcomes of pediatric EEF cases related to magnet ingestion and report our institution\u2019s experience with four such cases. Methods: A systematic review was conducted using PubMed\/Medline (January 1995\u2013February 2025), focusing on EEF after ingestion of \u22652 magnets in patients \u226418 years old. Studies reporting original EEF cases were included. Data extraction included demographics, clinical presentation, diagnostic imaging, intervention type, fistula number\/location, hospital stay, complications and outcomes. Four institutional cases were also analyzed. Results: Sixty-nine studies encompassing 130 pediatric patients were included. Median age was 3.3 years; 58% were male. The most common symptoms were abdominal pain (43%) and vomiting (29%). Abdominal X-ray identified magnets in all cases. Surgical intervention was required in 95.5%, while 5.5% were treated endoscopically. Ileal and jejunal fistulas were most common. Postoperative complications occurred in 19%, including bowel obstruction, infection and one death. Our four cases, aged 2 months to 5 years, each required surgery, with one patient readmitted for obstruction managed conservatively. Conclusions: Despite the case heterogeneity of this review, EEF is a potentially life-threatening complication of multiple magnet ingestion in children. Prompt diagnosis with abdominal X-ray and timely surgical management are essential. Increased clinical suspicion and public awareness are crucial for prevention and early intervention.<\/jats:p>","DOI":"10.3390\/jcm14176235","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T08:08:46Z","timestamp":1756973326000},"page":"6235","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Entero-Enteric Fistula Following Multiple Magnet Ingestion in Children: A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Natalia","family":"Kelaidi","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s General Hospital \u201cAghia Sophia\u201d, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9097-1502","authenticated-orcid":false,"given":"Konstantina","family":"Dimopoulou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Korgialenio-Benakio Red Cross Hospital, 115 26 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4470-263X","authenticated-orcid":false,"given":"Dimitra","family":"Dimopoulou","sequence":"additional","affiliation":[{"name":"Second Department of Pediatrics, Children\u2019s General Hospital \u201cAglaia & Panagiotis Kyriakou\u201d, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aggeliki","family":"Krikri","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s General Hospital \u201cAghia Sophia\u201d, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Siouli","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s General Hospital \u201cAghia Sophia\u201d, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0018-6584","authenticated-orcid":false,"given":"Maria M.","family":"Berikopoulou","sequence":"additional","affiliation":[{"name":"Second Department of Pediatrics, Children\u2019s General Hospital \u201cAghia Sophia\u201d, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2546-4533","authenticated-orcid":false,"given":"Nikolaos","family":"Zavras","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5021-5152","authenticated-orcid":false,"given":"Anastasia","family":"Dimopoulou","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s General Hospital \u201cAghia Sophia\u201d, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/0016-5085(88)90632-4","article-title":"Management of foreign bodies of the upper gastrointestinal tract","volume":"94","author":"Webb","year":"1988","journal-title":"Gastroenterology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"736","DOI":"10.3928\/0090-4481-20011201-08","article-title":"Gastrointestinal foreign bodies","volume":"30","author":"Chen","year":"2001","journal-title":"Pediatr. 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