Tiny Beads, Big Problems: Water Bead Ingestions—A Case Series

<b>Background:</b> Water beads are estimated to have caused >8000 emergency department (ED) visits from 2017 to 2022. Lethality after ingestion has been reported. The literature to guide management is scarce. We aimed to characterize three notable cases of water bead ingestions. <b>Methods:</b> We report the patient's presentations, diagnostic modalities, clinical courses, intervention(s) required, and outcomes of the three children who ingested water beads. <b>Results:</b> All patients (ages 8 months-36 months old) presented to the ED with concern for water bead ingestion. Two developed clinical small bowel obstruction and required laparotomy-both required repeat laparotomy after further expansion of previously missed beads. The third patient ingested dozens of water beads but did not develop an obstruction or require surgery. X-rays, cross-sectional imaging, and ultrasounds were employed with variable results. <b>Conclusions:</b> While variable bead expansion rates can necessitate multiple interventions in some children, older children may be less prone to obstructing after water bead ingestion. This case series demonstrates the variability in presentation, management, and outcome of an increasingly common pediatric surgical problem.