A Magnetic Pull: The Case Against Buckyballs
A 17-year-old young man presented to the emergency department shortly after inserting several dozen Buckyballs into his urethra, presumably for self-stimulation purposes. The patient was an honors student athlete at a local private high school who aspired to become an orthopedic surgeon. Aside from taking dexmethylphenidate for attention deficit hyperactivity disorder, his past medical history was unremarkable.
An attempt was made to remove the Buckyballs by exerting gentle traction on the tail end of the chain (Figure 1) was made. However, the internal balls had already contorted inside the bulbar urethra; thus, the chain separated at the meatus—leaving about 50 balls remaining inside (Figure 2).
The patient was then taken to the cystoscopy suite, where under general anesthesia, the balls were successfully removed individually over the next 3 hours via a 22 French cystoscope sheath and cold cup biopsy forceps (Figure 3). Recovery was aided by pushing their tangled mass up into the bladder and then teasing them apart 1 by 1 until all of the spheres had been extracted.
A catheter was placed overnight, and following its removal the following morning, he made an uneventful recovery. He was released to the custody of his parents, both of whom are physicians.
Last year, the US Consumer Product Safety Commission (CPSC) banned the sale of small but powerful rare earth toy magnets marketed under the name Buckyballs. This product is manufactured in China from an alloy of neodymium, iron, and boron, and then nickel plated. They look like harmless BBs about 4 mm in diameter, but are about 10 times stronger than ordinary magnets of the same size.
Over 500 million are unaccounted for in the United States since their introduction 5 years ago and are in the process of being recalled. If ingested, the balls are powerful enough to damage tissue and may sometimes require open surgery to remove them1; cases of bowel necrosis have been reported.2,3 While the majority of ingestions have involved the GI tract, cases of urogenital tract Buckyball insertion have also been reported.4 The case is notable for 2 aspects:
1. The patient was not mentally or physically challenged, as occurs in many situations with such features,5 which in extreme cases may lead to self-mutilation. In fact, he was an honors student.
2. We were able to remove the Buckyballs without resorting to open or percutaneous surgery.4 While this is by no means intended to trivialize the seriousness of the problem, this case shows that with persistence, it is possible to remove these foreign bodies with minimal morbidity.
The legal battles which accompanied the marketing and subsequent denouement of Buckyballs serve as an interesting backdrop to their medical implications.6,7 The main importer of Buckyballs, based in New York City, maintained until the end that CPSC was battling the free market. They pointed to personal/parental responsibility, citing the dangers posed by many common household items that may result in injury if used improperly or without appropriate supervision.
Nevertheless, the combination of a bored teenager, a rainy Sunday afternoon, and Buckyballs spelled trouble for our particular patient that day. ■
Lawrence M. Wyner, MD, is a professor of urology in the department of surgery at the Marshall University Joan C. Edwards School of Medicine in Huntington, WV.
1. Kosut JS, Johnson SM, King JL, et al. Successful treatment of rare-earth magnet ingestion via minimallly invasive techniques: a case series. J Laparoendosc Adv Surg Tech A. 2013;23(4):405-408.
2.Brown DJ. Small bowel perforation caused by multiple magnet ingestion. J Emerg Med. 2010;39(4):497-498.
3.Ng E, Bradbury RI, Khan N. Case report of bowel perforation after metallic ‘Buckyball’ ingestion. ANZ J Surg. 2013;83(6):489-490.
4.Alyami F, Himmelman J, Whelan T. A magnetic mass within the bladder. Can J Urol. 2013;20(5):6962-6963.
5.Balci U, Horsanali MO, Kartalmis M, et al. An unusual foreign body in the urinary bladder; beading awl. Turkish J Urology. 2011;37:275-277.
6.Ahmari S. What happens when a man takes on the Feds. The Wall Street Journal. August 30, 2013:A11.
7. Zucker Wins Against the Machine (editorial). The Wall Street Journal. May 19, 2014:A12.