A 1½-old girls presented with history of bilious vomiting for two days.
There was no history of incessant cry or bleeding per rectum. On
examination, the child had some dehydration. Abdomen was distended and
an ill defined mass was palpable just to the right of umbilicus. The
clinical suspicion was that of an intussusception, and the child was
admitted and intravenous fluids were administered. X-ray abdomen
revealed a single dilated bowel loop suggestive of small intestinal
obstruction. Ultrasound abdomen showed a thin walled clear cystic lesion
of size 3 x 3 cm in the ileum with proximal dilated loops suggestive of
a cystic duplication of ileum with intestinal obstruction.
The child was kept nil per orally and placed under
observation. The distension progressively increased and X-ray
abdomen after 6 hours showed increasingly dilated bowel loops, which
necessitated an emergency laparotomy. During surgery, a clear cystic
lesion of size 3x3 cm was found intraluminally in the jejunoileal
junction causing complete intestinal obstruction. The affected portion
of bowel was resected and a primary end to end jejunoileal anastamosis
was done. Post-resection, the specimen bowel was opened and a firm
translucent foreign body (Fig. I) densely adherent to
bowel was found in the lumen with focal discoloration and thinning of
the resected bowel.
Fig. 1 Hygroscopic foreign body inside
the small bowel.
Subsequent questioning of parents revealed the
presence of similar objects at their residence, bought from free market
for their hygroscopic properties, which explained the possibility of
accidental ingestion. The child had an uneventful postoperative period
and was discharged home after six days.
Superabsorbent polymer (SAP) beads causing intestinal
obstruction was first reported in in 2012 . A similar case of
ingestion of Superabsorbent crystal jelly in an infant causing
intestinal obstruction requiring surgery and subsequent mortality was
published subsequently from Pakistan . The toys involving these SAP
beads are banned in Malaysia, UK and Italy. The objective of presenting
this unique case is to alert the pediatricians to the existence of such
toys in the market, and alert them to educate the general public to
watchfully avoid such toys till a ban is enforced in India.
1. Zamora IJ, Vu LT, Larimer EL, Olutoye OO.Water-absorbing
balls: A "growing" problem. Pediatrics. 2012;130:e1011-4.
2. Mirza B, Sheikh A. Mortality in a case of crystal gel ball
ingestion: An alert for parents: APSP J Case Rep. 2012;3:6.