Surgeons Find Water Balloon Blocking Teen's Small Intestine

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In the latest edition of "How Did That Get in Your Small Intestine?" Australian surgeons Zheng Andrew Zhang, David Lan Cheong Wah, and Thair M Abbas Al-Dujaili present the tale of an "Unusual cause for small bowel obstruction" in the journal BMJ Case Reports.

At an unspecified time, an 18-year-old male visited a regional hospital near Melbourne, Australia complaining of nausea, vomiting, abdominal pain, and – most concerningly – total constipation over the previous five days. His physician ordered a CT scan to determine the cause of the blockage. Initial scans revealed that a blockage was indeed present, but evaluators could not make out any clear foreign objects.

Intraoperative photo showing small bowel dilatation (green arrow) and soft fluctuant mass in the terminal ileum (red arrow).

An emergency exploratory laparotomy did. Upon removing the small intestine, surgeons noticed a strange mass lodged in the pink, winding organ (see figure above). Cutting open the intestine itself, they found a bright red water balloon with a string attached. They removed the balloon and stitched the patient back up good as new.

Afterwards, physicians repeatedly asked the 18-year-old if he knew anything about the water balloon. The teen insisted he had no idea how it got into his bowels. Perhaps he was embarrassed and lied? Or maybe he was the victim of some prank? Regardless of the balloon's origin story, the teen swiftly returned to good health and was discharged with an appointment for a psychiatric review.

As the authors noted, ingesting foreign objects is extremely common, particularly for young children. Most incidents are completely harmless and resolve by themselves, but the rare few do require medical attention.

"Over 80% of ingestions resolve spontaneously and pass without a need for intervention. In 20% of cases, endoscopic intervention is indicated. Less than 1% of ingested foreign bodies require open surgical intervention," the authors wrote.

Included in that one percent, apparently, are water balloons.

Source: Zheng Andrew Zhang, David Lan Cheong Wah, Thair M Abbas Al-Dujaili. "Unusual cause for small bowel obstruction." BMJ Case Reports 2018; doi:10.1136/bcr-2018-227308

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