A rare case of colonic obstruction by 'cherry tomato' phytobezoar: A simple technique to avoid enterotomy

A rare case report of teen-onset pica in a female patient with a clinical high risk for psychosis

AIM

We aimed to further elucidate the under-researched, underdiagnosed and misunderstood comorbid pica in the context of psychosis.

METHOD

We report a case of teen-onset plastophagia in an antipsychotic-naïve girl at ultra-high risk (UHR) for psychosis.

RESULTS

HA is a 17-year-old unmarried girl who had a history of good premorbid functioning, no personal psychiatric history and an uncle with schizophrenia. She was referred to our psychiatry department with the complaint of having the habit of eating plastic for about 2 years. A thorough clinical history revealed that she developed, since more than a year, difficulty in school and interpersonal functioning. After clinical evaluation, a diagnosis of UHR with major depressive disorder, iron deficiency anaemia and pica was made.

CONCLUSION

We draw attention to the possibility of an overlap between the pathogenesis of pica and psychosis, and we highlight the importance of early diagnosis and management of both pica and UHR since they can lead to serious medical and mental consequences.

Mango seed causing acute large bowel obstruction in descending colon-world's first reported case

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Phytobezoars are a rare cause of large bowel obstruction.

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It should be included in the differentials in patients with no specific symptoms and signs of colorectal cancers.

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Conservative and or Colonoscopic approach should be attempted first, in all patients with no signs of peritonitis.

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Patients who present in an acute setting with signs of peritonitis require laparotomy even when the diagnosis is a benign phytobezoar.

Introduction

Phytobezoars are a very rare cause of large bowel obstruction. Mango seeds as a phytobezoar causing large bowel obstruction have not been reported in the English literature.

Presentation of case

We present the case of a 69 years old female who presented to us with clinical and radiological signs of acute large bowel obstruction. On laparotomy, it was noted that mango seeds as a phytobezoar was responsible for the obstruction in the descending colon.

Discussion

Phytobezoars are a rare but known cause of small bowel obstruction. Large bowel obstruction is even rarer. The literature has documented a few cases of small bowel obstruction caused by mango seeds but none for large bowel obstruction. The most frequent reported sites of large bowel obstruction are the sigmoid colon and recto-sigmoid junction. However, phytobezoar causing descending colonic obstruction without any pre-existing underlying pathology has not been reported.

Conclusion

The association of bezoar with acute large bowel obstruction is a very rare however; it must be entertained in the differential diagnosis of any large bowel obstruction. Early diagnosis and treatment can avoid lethal complications. Our case being the first case of mango seeds phytobezoar in descending colon with acute large bowel obstruction; signifies its importance for reporting in the English literature.

Removal of a Giant Rectosigmoid Phytobezoar without Laparotomy

Bezoars are the uncommon result of ingestion of indigestible or poorly digestible substances. Phytobezoars are the most common bezoars in children. Small bowel obstruction, especially of the terminal ileum, is the most common complication. Colonic obstruction is rare. Most reviewed intestinal phytobezoars with obstruction necessitate laparotomy with enterotomy. Here, we report a rare case of giant rectosigmoid phytobezoar with near-total colonic obstruction. Successfully, removal of this bezoar by an alternative way of fragmentation with colonoscopy, not conventional enterotomy is needed. The patient recovered well and then discharged without any morbidity 2 days later.

Colorectal lithobezoar: A rare case report

We report an unusual case of a giant lithobezoar that was extending from the caecum to the anal canal, and the patient had no features of absolute constipation or peritonitis. It is believed to be the first such giant colonic lithobezoar in the literature.

Sunflower rectal bezoar presenting with an acute abdomen in a 3-year-old child

This is a case of a 3-year-old boy with a sunflower-seed rectal bezoar who presented to our emergency department with fever, abdominal pain, leukocytosis, vomiting, and an examination concerning for appendicitis. A failed diagnostic imaging attempt ultimately led to the diagnosis. Children with rectal bezoars typically present with diarrhea, rectal pain, and tenesmus. Our patient presented atypically and developed significant colitis secondary to the bezoar. We discuss bezoars and the uncommon rectal seed bezoar. This case illustrates an atypical complication (colitis) of an unusual condition (rectal bezoar) mimicking a relatively common illness (appendicitis).

Intestinal Obstruction Due to Phytobezoars of Banana Seeds: A Case Report

Phytobezoars are a well-known, though rare, cause of mechanical alimentary tract obstruction. They occur mainly in patients who have undergone abdominal surgery, where most literature reports describe the causes as persimmons and oranges. We report four cases, seen within a period of 19 months in Laos, with intestinal obstruction caused by phytobezoars from jungle banana seeds. They had no history of previous gastrointestinal surgery. The recommended therapy in total obstruction is laparotomy, "milking" through the ileocaecal junction, or enterotomy and direct extraction. As recurrence and presentation at multiple sites are possible, all of the gastrointestinal tract should be thoroughly examined intraoperatively.

Surgical issues in the poisoned patient

Some toxicologic emergencies require immediate or urgent surgical intervention in addition to routine medical care. The EP must be familiar with the indications for operative care, even though many of these poisonings and exposures are relatively rare. The EP must also be knowledgeable regarding the various means of surgical decontamination that are available, including temporary cardiopulmonary bypass. Finally, a high level of vigilance must be maintained for patients who have delayed presentation and fulminant organ failure necessitating early involvement of the transplantation team.