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's experience with four such cases. Methods: A systematic review was conducted using PubMed/Medline (January 1995-February 2025), focusing on EEF after ingestion of ≥2 magnets in patients ≤18 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.
Keywords: children; entero-enteric fistula; gastrointestinal complications; magnet ingestion; neodymium magnets; pediatric surgery.