Abstract / Summary
Ingestion of multiple high-powered neodymium magnets is a uniquely dangerous paediatric emergency. When distributed across non-contiguous bowel segments, transmural magnetic attraction causes progressive vascular compression, ischaemia, necrosis, and perforation. The incidence has risen sharply over the past decade, driven by the widespread availability of neodymium magnetic bead toy sets. Diagnosis is frequently delayed because children are often asymptomatic initially, creating a deceptive window during which bowel injury silently advances. A three and a half-year-old presented with bilious vomiting and fever without a reliable ingestion history. Plain radiograph revealed the stacked magnet sign across multiple abdominal quadrants. Conservative management failed the six-hour non-progression threshold, necessitating laparotomy. Magnets in the stomach, proximal jejunum, and transverse colon were drawing all three loops into stacked apposition with near-full-thickness ischaemia at each contact site. All were retrieved via gastrotomy and enterotomies; primary two-layer closure was performed. Recovery was uneventful. The stacked magnet sign mandates immediate surgical consultation. Adherence to the six-hour non-progression rule enabled timely laparotomy before frank perforation, which was directly responsible for the favourable outcome.