Duodenal Obstruction in a Child who Ingested Superabsorbent Polymer Ball

Abstract

A two-year-old girl was brought to our emergency department owing to repeated vomiting and general malaise. She presented with nonbilious vomiting, tachycardia and drowsiness. Abdominal examination showed marked distention in the upper abdominal region, without tenderness. Blood tests indicated jaundice, elevated urea nitrogen levels and hyperamylasemia. An abdominal ultrasound revealed a membranous structure in the second part of the duodenum with a marked expansion of the stomach in association with the dilatation of the common bile duct and pancreatic enlargement. CT and MRI revealed a simple cyst of 4 cm diameter in the second part of the duodenum. An upper gastrointestinal contrast study showed a bulbar filling defect in the second part of the duodenum, and the contrast medium did not spread distally. Thus, a tentative diagnosis of duodenal duplication cyst in conjunction with obstructive cholangitis and pancreatitis was made. Laparotomy revealed a large ball-shaped foreign body in the duodenum, which was removed successfully. At postoperative counseling, we showed the extracted ball to the patient’s mother, who confirmed that the girl had placed this foreign body in the mouth preclinically. Accordingly, we diagnosed the patient as having duodenal obstruction due to the ingestion of a superabsorbent polymer ball. The postoperative course was uneventful. This case report highlights the extreme danger of superabsorbent polymer balls for children, which should be kept in mind when investigating the sudden onset of vomiting in pediatric patients.