ENDOSCOPIC MANAGEMENT OF COMPLETE BOWEL OBSTRUCTION SECONDARY TO INGESTION OF WATER ABSORBING BEADS

Seyed A Arshad, MD, Andrew Christensen, MD, Edward Auyang, MD, MS, FACS, Jason Mckee, MD, FACS. University of New Mexico

Pediatric foreign body ingestion is a common issue with a reported 100,000 ingestions per year [1]. Most of these are accidental with a high majority being coins. A reported 50-90% of foreign bodies pass spontaneously, with 10-20% requiring removal, and less than 1% requiring surgical intervention [2]. The ingestion of Orbeez, water absorbent polymer beads, has increased in the past years with a 110 patient case-series published describing no reports of intestinal obstruction as well as in-vitro studies concluding low risk of obstruction [3,4]. There have however been two publications of intestinal obstruction secondary to these beads, each requiring operative intervention [5,6]. Described is the case of a rare complete bowel obstruction secondary to ingestion of these water absorbing beads, managed non-operatively with upper endoscopy.

An otherwise healthy 19-month-old female presented with a one day history of nausea, vomiting, and intoleration of oral intake. During a bout of emesis, the patient expelled a 1cm fully saturated bead, concerning the parents for foreign body ingestion. The patient underwent a computed tomography (CT) scan, which was significant for a dilated second portion of the duodenum with non-passage of oral contrast beyond the stomach. Given the patient’s clinical and radiographic findings, there was concern for complete bowel obstruction at the level of the proximal duodenum.

Under general anesthesia, an upper endoscopy was performed. The scope was advanced to the duodenum where a mass of gelatinous material from the saturated beads was fully obstructing the lumen. Due to the location and impacted nature of the beads, attempts at intact bead removal were unsuccessful. Using a grasper, the beads were further broken down and suctioned through the scope piece-meal until the obstruction was resolved. The scope was then able to be advanced beyond the ligament of Treitz, assuring resolution of the obstruction. Post-operatively, the patient’s diet was able to be advanced and was subsequently discharged with no long-term sequela.

Although common in the pediatric population, foreign body ingestion rarely requires operative intervention. There have now been two case reports of bowel obstruction secondary to these water-absorbing beads, but all previous cases have opted for operative intervention. We believe this is the first case describing endoscopic management of complete bowel obstruction secondary to these beads. Although one must be prepared to continue on to operative intervention, endoscopic evaluation and management is a safe and effective initial approach to this rare, but increasing cause for obstruction.