O2149: The Hidden Dangers: Superabsorbent Polymer Beads as an Increasing Cause of Bowel Obstruction in Children

Background: Superabsorbent polymer (SAP) beads, commonly found in children’s toys, home decorations, and gardening products, have the ability to expand up to 400 times their original size, presenting a distinctive challenge when ingested by children. While many pass through the gastrointestinal tract without incident, some instances lead to urgent surgical intervention due to bowel obstruction. Our study aims to present an updated systematic review of existing literature, summarize our institution’s experience, and introduce an innovative in vitro experiment aimed at mitigating the need for future surgical interventions by exploring methods to reduce the size of enlarged SAP beads.

Methods: A systematic review was conducted utilizing PudMed and Google Scholar databases to identify cases of SAP bead ingestion in children associated with bowel obstruction. Patient demographics, clinical manifestations, diagnostic approaches, treatment strategies, and outcomes were extracted for descriptive analysis. Additionally, we add an unpublished case encountered within our institution. Furthermore, an in vitro experiment was devised wherein SAP beads were cultivated within a simulated intestinal environment (normal saline at 37°C) and subsequently subjected to agents with varying osmolarities to investigate potential size reduction mechanisms.

Results: We identified 88 patients from 46 studies who experienced bowel obstruction following SAP bead ingestion, alongside an additional patient from our institution. Forty-two studies (n=50) provided individualized information and were included in the descriptive analysis. The average age was 14.2 (±4.6) months, with females comprising the majority (64%) of patients. Predominant clinical symptoms included emesis (92%) and abdominal distention (48%). While abdominal X-rays were conducted in 74% of cases, only 5.4% visualized the foreign body. Conversely, ultrasound, performed in 56% of cases, successfully visualized the foreign body in 85.7% of instances. The most frequent sites of obstruction were the jejunum (42%) and the ileum (44%). 84% of patients required abdominal surgery, predominantly undergoing enterotomy for SAP bead removal (70%). The average bead size at retrieval was 33.7 (±8.3) mm. Postoperative complications occurred in 18.4% of cases, the majority of which were reoperations (16%) to remove additional beads not identified in the initial procedure. One mortality was recorded. In the in vitro experiment, the beads were grown to an average size of 28.8 mm. The hyperosmolar solution GoLYTELY contributed to a 37% reduction in the size of expanded SAP beads within 12 hours, demonstrating its efficacy alongside other solutions such as Gastrografin, prune juice, and acetylcysteine.

Conclusion: Due to the increased frequency in the number of cases published each year describing bowel obstruction after SAP bead ingestion, increased education efforts are required for prompt diagnosis and removal. Encouragingly, the use of hyperosmolar agents holds promise in effectively reducing SAP bead size and thus may offer a future proactive strategy to diminish the necessity for surgical interventions in affected children.