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Review
. 2025 Feb;61(2):204-208.
doi: 10.1111/jpc.16730. Epub 2024 Dec 7.

Water beads: Expanding toy and 'new' problem for paediatric surgeons and community

Taisia Bollettini  1 , Mirella Mogiatti  2 , Alice Benigna  1 , Angelica Finelli  1 , Francesco Ferrara  1 , Veronica Pardi  3 , Raffaele Macchiarelli  3 , Mario Messina  1 , Valerio Gentilino  2 , Francesco Molinaro  1 , Rossella Angotti  1
Affiliations
Review

Water beads: Expanding toy and 'new' problem for paediatric surgeons and community

Taisia Bollettini et al. J Paediatr Child Health. 2025 Feb.

Abstract

Background and study aims: Water beads made from superabsorbent polymers can lead to bowel obstruction, which can sometimes be fatal. This article aims to highlight the dangers of such toys and to propose an innovative, safe and effective approach to diagnostic and therapeutic management.

Patients and methods: We report two cases of children with intestinal obstruction following the ingestion of products based on superabsorbent polymers. They were diagnosed and treated in two different centres using varying techniques.

Results: We compare our experiences with the few cases reported in the literature. Since water beads are radiolucent, ultrasound or CT scans are crucial for diagnosis. As in one of our cases, radiography of the upper gastrointestinal tract with contrast can be very helpful. Laparotomy with enterotomy is the main surgical approach reported in literature to extract the water spheres. We report two cases managed using a minimally invasive approach, and one of them is the second one described in the literature, treated endoscopically.

Conclusions: Water beads pose a potential danger to children, making it necessary to limit the sale of this type of toy. We offer a management flowchart based on our experience and evidence from the literature.

Keywords: endoscopy; laparoscopy; paediatric surgery case reports; superabsorbent polymers; water beads case reports.

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Figures

Fig. 1
Fig. 1
(a) Contrast upper gastrointestinal radiography: a radiopaque spherical image with a diameter of 3–4 cm in correspondence with the first jejunal loop (arrow), about 3 cm from the Treitz. (b) Endoscopy view: a large water bead obstructing the third portion of the duodenum.
Fig. 2
Fig. 2
(a) Ultrasonography: jejunoileal loops show distension up to 25 mm containing round anechoic ball formation. (b) After enterotomy, the intraluminal foreign bodies were pushed to the most distal sphere.
Fig. 3
Fig. 3
Flowchart for the management of water bead ingestion.
See this image and copyright information in PMC

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