Retained crystal ball in pediatric gastrointestinal tract: a cautionary case report

Decorative crystal balls, also known as superabsorbent polymer gel beads, pose a significant hazard when ingested due to their ability to expand upon exposure to water. Diagnosing crystal ball ingestion remains challenging because of their transparency to radiation, making them difficult to visualize using X-ray imaging. Small crystal balls may not be detected in their early stages, only becoming visible once they fully swell and cause intestinal obstruction. This often results in some crystal balls remaining in the distal intestine after primary surgery aimed at removing the proximal crystals.

A 2-year-old girl was referred to our hospital with persistent vomiting and fever. She was diagnosed with acute intestinal obstruction, and imaging revealed features of dynamic obstruction. Emergency laparotomy identified an obstruction in the mid-terminal ileum caused by a superabsorbent polymer gel bead (crystal ball). A jelly-like mass measuring 4x4.5 cm was removed and sent for histopathological examination. Intestinal anastomosis was performed during the initial surgery to restore bowel continuity. Postoperatively, complications arose, including infection in the abdominal cavity and breakdown of the anastomosed area. A previously missed gel bead, referred to as "crystal baby," which had not been identified during the initial surgery, caused severe leakage and infection. Given the high risk of further anastomotic complications, a double-lumen ileostomy was performed. The child's condition improved, and follow-up imaging one month after surgery revealed no further obstruction.

This case highlights the diagnostic and surgical challenges associated with crystal balls (superabsorbent polymer gel beads) and emphasizes the need for careful management to prevent severe complications. It also underscores the risks of intestinal anastomosis in such cases and the necessity of alternative approaches, such as ileostomy, to ensure better outcomes.