Ultrasound Diagnosis of Crystal Jelly Ball Ingestion Causing Intestinal Obstruction

Case Series

Austin J Radiol. 2016; 3(2): 1046.

Ultrasound Diagnosis of Crystal Jelly Ball Ingestion Causing Intestinal Obstruction

Faizah MZ¹*, Soon YY¹, Che Zubaidah CD², Mohd Yusof A³ and Dayang AA4

¹Department of Radiology, Universiti Kebangsaan Malaysia Medical Center, Malaysia

²Department of Diagnostic Imaging, General Hospital of Kuala Lumpur, Malaysia

³Department of Pediatric Surgery, General Hospital of Kuala Lumpur, Malaysia

4Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Malaysia

*Corresponding author: Faizah MZ, Department of Radiology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia

Received: January 18, 2016; Accepted: February 23, 2016; Published: February 24, 2016

Abstract

Ingestion of Foreign Bodies (FB) by young children is a common presentation in the emergency department. We present two cases which were diagnosed with intestinal obstruction. Abdominal ultrasound revealed an intraluminal anechoic cystic lesion causing intestinal obstruction in both cases. We discuss the ultrasound findings of an intraluminal crystal jelly ball FB highlighting the technical consideration on ultrasound probe selection. In both cases, Intraoperative findings confirmed that the small bowel obstruction was due to a crystal jelly ball bezoar.

Keywords: Ultrasound; Jelly ball; Intestinal obstruction

Introduction

Foreign Body (FB) ingestion can cause serious morbidity and mortality, especially among children aged six months to three years [1,2]. Unfortunately, almost half of these cases are not witnessed and often the child does not develop symptoms until presented with complications [3]. There is very little discussion in the literature regarding ultrasound appearance of a radiolucent intraluminal FB such as a crystal jelly ball. Previous literature did not describe the ultrasound findings but the radiograph and CT findings instead of this unique FB ingestion [4]. We aim to present a case series of crystal jelly ball ingestion emphasizing on the ultrasound findings. Ultrasound is a preferred imaging modality in children as it is readily available and no radiation involved. There was no history of FB ingestion prior to the pre-operative ultrasound in both cases.

Case Series

Case 1

An 18 month old girl presented with a history of two days of vomiting with poor oral intake. There was no associated fever or diarrhoea. Upon examination, she was dehydrated and lethargic. Her abdomen was still soft, non-tender and not distended. She was admitted and treated for acute gastroenteritis. The following day, she developed bilious vomiting.

Abdominal ultrasound using a L12-5 MHz superficial probe Philips IU22 ultrasound (Eindhoven, The Netherlands) demonstrated a well-defined anechoic thin-walled, intraluminal cystic lesion. The lesion was suspected to be in the splenic flexure as it was located at left hypochondrium with presence of dilated right sided colon. The provisional diagnosis was an enteric duplication cyst since there was a “double wall sign” noted (Figure 1).