'Tinkling' sound in Cork toddler's tummy leads to removal of five magnetic balls from intestine

Jun 29, 2023

The boy underwent an emergency exploratory laparotomy procedure at CUH, during which five magnetic, metallic balls were surgically removed, along with a 4cm section of his small intestine. File Picture

A two-year-old boy had five magnetic balls surgically removed from his small intestine after doctors at Cork University Hospital heard a “tinkling” sound coming from his tummy.

The toddler had been brought to the emergency department suffering from abdominal pain, vomiting and dehydration. He had not had a bowel movement in three days and was not passing any wind.

He was admitted and doctors initially suspected gastroenteritis but sent him for an X-ray and CT scan of his abdomen after detecting abnormal “tinkling” sounds, according to a case report published in the latest issue of the Irish Medical Journal.

The scan revealed that a “metallic, spiral-shaped object” was causing a bowel obstruction, although the exact nature of the blockage remained uncertain.

The boy underwent an emergency exploratory laparotomy procedure, during which five magnetic, metallic balls were surgically removed, along with a 4cm section of his small intestine.

The authors of the report from the hospital’s paediatric department and University College Cork said the case demonstrated that the unwitnessed ingestion of a foreign body should always be considered a possibility in such situations.

“Timely diagnosis of a bowel obstruction is key to reducing morbidity in this cohort of patients,” they warned.

“Subtle clinical findings like absent bowel movements and tinkling bowel sounds in the absence of flatus will always need to be considered a red-flag symptom of non-specific bowel obstruction.”

They noted that the ingestion of foreign objects was a “common phenomenon” in paediatrics, and the majority of ingested foreign bodies pass spontaneously. However, between 10% and 20% of patients require endoscopic retrieval in these circumstances, and 1% require surgical extraction.

“Radiological imaging plays a vital role in diagnosing an unwitnessed foreign body bowel obstruction. Similarly, this case demonstrated that, although he fulfilled many of the diagnostic criteria for early viral gastroenteritis, an unwitnessed foreign body ingestion should always be considered as a differential in these case presentations,” the case report stated.