Dr. Alicia Greene - Best of the Best in Pediatric Surgery 2025

All right. We are going to move on now to the final, uh, heat. And um, this is now, this is the final heat of three societies, Apsa, AAP and Ipeg. Um, so uh, for AAP, our first uh, paper is Dr. Alicia Green, and she's talking about the hidden dangers, uh, super absorbent polymer beads as an increasing cause of bowel obstruction in children. I do actually get worried about this myself. Uh, Penn State Children's Hospital in Hershey, Pennsylvania. My name is Alicia Green and I'm a third year General Surgery resident at Penn State University. Our project is titled the hidden dangers, super absorbent polymer beads as an increasing cause of bowel obstruction in children. We have no disclosures. Foreign body ingestion remains a dilemma in the pediatric population. I'm sure we are all familiar with X-rays such as the one scenes here that involve children swallowing coins, button batteries and magnets. So today I will shift our attention to an object that has more recently become a growing problem for young children over the past decade. More recently, super absorbent polymer or SAP beads, commonly known as water beads, have raised significant concerns due to ingestion by children. SAP beads are commonly utilized in children's toys, home decorations and gardening supplies. Their ability to expand in liquids puts children at risk for bowel obstruction after ingestion. In part one of our project, we performed a review of the literature of reported SAP bead ingestion with bowel obstruction in young children. We extracted patient characteristics, imaging findings, treatment modalities and outcomes. Given the high rate of surgical intervention in these cases, we also performed an in vitro experiment to evaluate the efficacy of several solutions in reducing expanded beads. We initially grew small, medium and large beads and simulated small bowel fluid. We then took the expanded beads and transferred them to various solutions, all deemed safe for pediatric ingestion of different osmolarities. We measured the diameter of the beads before exposure and at varying time points after exposure. We hypothesized that hypertonic solutions would exhibit the greatest reduction in diameter of the SAP beads compared to other conditions. For our literature review, we identified 87 cases from 45 publications. We found that the number of cases has significantly increased over the last decade. From these studies, the average patient age was 14 months. Only 16% of patients had a witnessed ingestion of the foreign body. Abdominal X-rays were performed in 74% of cases, but only 6% commented on a visualized foreign body. Conversely, ultrasound performed in 57% of cases successfully visualized a foreign body in 86% of instances. Definitive retrieval of the beads was achieved with surgery in 84% of cases and endoscopy in 8% of cases. The mean bead size at retrieval was 33.7 millimeters. Post-operative complications occurred in about 19% of cases, the majority of which were reoperations to remove additional beads not identified in the initial procedure. Two patients experienced an anastomotic leak requiring an iliostomy. The median hospital length of stay was six days and one mortality was recorded. In our in vitro experiment, growth was observed in small, medium and large beads in normal saline at internal body temperature. The maximum rate of growth was observed in the first hour for the small and medium beads and between hours 1 and 3 for the large beads. The medium beads had the greatest growth rate at 305% and no beads demonstrated clumping at any time. We then transition to part two where the SAP beads were grown and then transferred to different solutions. Only the medium and large beads were used for this portion since the small beads only reached a maximum diameter of less than 1 centimeter, which we did not think would be clinically significant to result in a small bowel obstruction if ingested by young children. The medium and large beads were grown to an average size of 2.8 centimeters. Once transferred to different solutions, the greatest reduction in size after 24 hours was noted in beads exposed to go lightly with almost a 40% size reduction, followed by prune juice, gastrografin and 10% acetylcystine. Our results are not without limitations. The literature review contained case reports and case series with limited descriptive data. These reports did not stratify for potential confounding variables and may contain selection or reporting bias. Also, our in vitro experiment was conducted in normal saline in a beaker and not with actual bilius small bowel content in simulated intestine. In conclusion, despite recalls of some products, the number of cases of obstruction in children following ingestion of SAP beads has significantly increased over the last decade. In addition, timely diagnosis and intervention are critical. Moreover, during surgery, a thorough examination of the entire bowel and a high index of suspicion for multiple beads is essential. And lastly, hyperosmolar solutions and osmotic laxatives may have the potential to reduce the size of SAP beads if ingested by children. I would like to thank Dr. Walter Colton and Dr. Gregory Yocom for generously providing access to their lab for our experiment. And I would also like to thank our research team listed here, especially my mentor and PI Dr. Brianna Emer. Thank you again for the opportunity to share our work. Thank you for this. It's so frustrating to me. I'll be honest because um, I still see all the little mini bat little magnets being sold in stores and we, you know, I so we now see this. I don't know as pediatric surgeons if we have any influence and advocacy because it seems that even when we wrote letters and all that, it doesn't uh it doesn't seem to make a difference. So that's number one thing I just wanted to point out. I don't know if there's a better plan or if they even care. The second thing is, um, I was fascinated that they were able to remove some of these with endoscopy. I can imagine that's not so easy uh because they just because it's probably unless they use the basket because the the grasper seems like they would just slip right out. Um, and I love that you weren't just reporting the incidents but you were talking about a therapeutic and I think that is a great idea. So great presentation. I don't know if you have any comments. Yes, thank you so much for your comments and thank you for the opportunity to share our work. Um, our group was actually invited by the AAP and Apsa advocacy group um to share our findings and meet with some representatives from the national recall companies to start developing a plan to recall certain products. Of course, they won't be able to recall all products, but maybe the larger beads that are being sold by certain companies, um, which don't seem to be produced as much but seem to be causing the majority of the problems. We also participated in a uh news press uh down at AAP and shared our results to try to bring awareness to the fact. Um, the your second point on endoscopy, um it was used in a handful of patients. Um it seems like a basket was used in certain cases. Of course, they could only reach beads mainly in the dunum, um maybe proximal jejunum. Um, studies have found though that just breaking up the beads will allow them to sometimes be able to be passed. Um, so most of them use the basket but some of them were able to kind of crush up the beads into small pieces and then allow them to pass on their own. Awesome. Great work. Thank you so much. Thank you.