Sunflower seed rectal bezoar in an adult

Fecal impaction in children: report of 53 cases of rectal seed bezoars

BACKGROUND

Rectal seed bezoars in children seem to present an uncommon problem that necessitates some operative intervention.

PURPOSE

Our objective is to determine the occurrence and clinical characteristics of rectal seed bezoars in children with fecal impaction.

METHODS

A retrospective review of hospital records of children with discharge diagnosis of fecal impaction was conducted from 1996 to 2005 in a university-affiliated general hospital

RESULTS

The study group is composed 59 children. A total of 53 had rectal seed bezoars: watermelon seeds in 43 children, prickly pear seeds in 6, sunflower seeds in 3, and pumpkinseeds in 1. Six children had seedless fecal impaction. All the children with seed bezoars were of Arab origin. Fifty children were treated under general anesthesia. Of the remaining 9 children, 5 underwent digital disimpaction without general anesthesia: 3 with seedless feces and 2 with rectal seed bezoars. Four children with rectal seed bezoars evacuated spontaneously without digital disimpaction. There was summer seasonal preference for watermelon and prickly pear seed bezoars, whereas sunflower seed bezoars occurred in the spring.

CONCLUSIONS

Fecal impaction owing to rectal seed bezoars is more common than previously believed. Its occurrence among Arab children alone in this study might indicate a high proportion of fecal seed bezoars throughout the Middle East. We propose that the preferred treatment should include disimpaction and irrigation of the rectal content under anesthesia. Greater awareness by primary care practitioners and parents might be beneficial in its prevention in the future.

Fecal impaction in adults: report of 30 cases of seed bezoars in the rectum

PURPOSE

Seed bezoars in the rectum have been considered an uncommon cause of fecal impaction in adults. Although there have been several reports on sunflower seed bezoars, seed bezoars from the fruit of the prickly pear cactus and watermelon have received little notice. This study was designed to determine the frequency of fecal impaction by seed bezoars in the rectum and their clinical characteristics in adults.

METHODS

A retrospective review of the medical records of patients hospitalized with the diagnosis of fecal impaction during a ten-year period.

RESULTS

During the study period (January 1996 to December 2005), 55 patients were hospitalized at the Western Galilee Hospital, in northern Israel, with the diagnosis of fecal impaction. Phytobezoars were found in 30 patients (55 percent). The seed bezoars were composed of prickly pear seeds in 12 patients, watermelon seeds in 10 patients, sunflower seeds in 4 patients, popcorn kernels in 1 patient, and pomegranate seeds in 1 patient. The Jew:Arab ratio for seed bezoars was 7:23. Seventy-three patients had seedless fecal masses with a Jew:Arab ratio of 58:15. All 30 patients with bezoar underwent digital disimpaction under general anesthesia. Only 21 of 73 patients with seedless fecal masses were treated under general anesthesia.

CONCLUSIONS

Seed bezoars found in the rectum were the most common cause of fecal impaction requiring hospitalization, probably to the result of the eating habits in the Middle East. The consumption of seeds with shell fragments or fruits containing many seeds (such as the prickly pear) should be accompanied by the awareness that large quantities may cause fecal impaction.

Prickly pear fruit bezoar presenting as rectal perforation in an elderly patient

BACKGROUND AND AIMS

Prickly pear fruit rectal seed bezoars are an extremely rare entity. Only nine cases of rectal seed bezoar have been reported, only one of which involved the prickly pear fruit seed. Furthermore, to our knowledge, this is also the first reported case presenting as rectal perforation.

PATIENTS AND METHODS

We report a case of prickly pear fruit bezoar occurring in the elderly whom presented with rectal perforation. Consistent with physical signs, laboratory results, and radiological findings the patient was diagnosed with acute perforation of the rectum. A Hartman procedure was performed, and a colostomy was placed.

RESULTS

Currently there are very few data regarding seed bezoars reaching the rectum. There are even fewer data concerning this occurrence in the elderly, and the literature contains no report of this phenomenon presenting or even progressing into perforation. We report this rare entity to the existing literature.

CONCLUSION

We report a rare but important case. A prickly pear fruit phytobezoar presenting as rectal perforation. This case may add to the increasing awareness of the danger associated with ingestion of certain foodstuffs. The previously benign sunflower and psyllium seeds are now known to cause bezoar. We feel that the prickly pear fruit should join this small but important list.