'Water balloon' causing bowel obstruction: BMJ case report
An 18-year-old man presented with a 5-day history of persistent nausea, vomiting, absolute constipation and generalised abdominal pain. On clinical examination, he was tachycardic (116 beats/min) with a low-grade temperature (37.8°C), and had abdominal distension with central abdominal guarding. Plain films showed dilated loops of small bowel, consistent with small bowel obstruction.

Subsequent evaluation with a CT scan demonstrated the appearance of small bowel obstruction with at least one transition point in the left lower abdomen, with features concerning for internal herniation or mesenteric torsion resulting in closed-loop obstruction. No foreign objects were seen at the initial reporting of imaging. A nasogastric tube was placed and an emergency explorative laparotomy was performed for concerns of closed loop bowel obstruction.

Intraoperatively, small bowel dilatation was found throughout, up to the distal ileum. A soft, fluctuant and intraluminally mobile mass of approximately 4 cm in length was palpated in the distal ileum. The mass was causing severe obstruction, and the bowel distal to this was collapsed. Enterotomy revealed a water-filled rubber balloon.

No history of foreign body ingestion was given by the patient on repeat assessments postoperatively. Given the density of the water balloon, only on a retrospective review of the initial CT imaging was the foreign body identified. The patient was discharged home after tolerating enteral nutrition and outpatient psychiatry review organised.

Highlights
• Radiolucent objects may not be localised on radiographic investigations and a reliable history is not always available.

• Complications of foreign body ingestion include ulcer formation, mucosal laceration, perforation, intestinal obstruction, fistula formation and bacteraemia.

Read more here: http://casereports.bmj.com/content/2018/bcr-2018-227308.full
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