Ingestion of kinetic sand leading to intussusception and bowel obstruction in a child: a case report

Abstract

Background: Kinetic sand is a type of play sand that is marketed to children above the age of three years old. It is comprised of sand coated with silicone oil, holding its shape when squeezed or pressed. It is described as a non-toxic, hypoallergenic, safe sand for arts and crafts, and is highly appealing due to its realistic appearance and odor. We present the first reported case of bowel obstruction due to small and large bowel intussusceptions caused by ingestion of kinetic sand leading to hospitalization for medical treatment in a young girl.

Case description: We present a two-year-old female patient with a past medical history of autism, trichotillomania, and pica who presented to our hospital as a transfer for two days of abdominal pain and non-bloody bilious emesis. Radiographic workup included abdominal ultrasound, abdominal X-ray, and computed tomography that revealed both small bowel intussusceptions and colo-colonic intussusception. Fluoroscopic gastrografin enema was performed and yielded free reflux of contrast into the distal ileum. The admitted patient continued to pass the sand with an eventual resolution of abdominal pain.

Conclusions: Intussusception is considered a medical emergency and should be treated as soon as possible before potentially fatal complications occur. This report serves to highlight the potential dangers of kinetic sand ingestion and provide guidance for the management of intussusception and bowel obstruction after kinetic sand ingestion in the pediatric population.

Keywords: Small bowel obstruction; case report; kinetic sand; pediatric emergency.

Figure 1

Initial radiograph demonstrates a soft tissue density in the right lower quadrant (blue circle). There is linear hyperdensity within it that represents a concretion of the sand (white arrow). Distended air-filled loops of small and large bowel are worrisome for a developing obstruction (blue arrow).

Figure 2

Subsequent ultrasound shows intussusception in the right lower quadrant with a target sign of alternating hyper and hypoechoic rings of bowel wall (blue circle). Echogenic sand collections (white arrows) are also seen within the intussuscipiens.

Figure 3

Computed tomography image shows multiple small bowel/small bowel intussusceptions (white arrows) with the high-density sand concretion in the intussuscipiens (blue arrow). The high-density sand concretions are also able to be seen in the right lower quadrant (orange arrows).

Figure 4

Axial contrast enhanced computed tomography image demonstrating suspected colo-colic intussusception (blue circle).

Figure 5

End image from a water soluble, gastrografin enema shows reflux of contrast into the small bowel loops (blue circle).

Figure 6

Timeline of patient events prior to and during hospital course. US, ultrasound; CT, computed tomography; XR, X-ray.