Phytobezoar-An Unusual Cause of Small Bowel Obstruction in Pediatric Age Group: A Case Report and Literature Review

Abstract

Phytobezoars are the most common and well known type of bezoars yet one of the uncommon causes of mechanical obstruction of the small intestine. The reported prevalence rate of phytobezoars is estimated to be 0.4% despite being the 5th most common cause of acute small bowel obstruction. A previously healthy five-year-old girl presented to the Emergency Medicine Department with a 5-day history of nonprojectile, nonbile stained vomiting, abdominal pain, and decreased urine output. Physical examinations revealed severe dehydration symptoms, and laboratory tests indicated abnormal electrolyte levels and metabolic alkalosis. The patient experienced a seizure, received medical interventions, and was diagnosed with mechanical intestinal obstruction due to a phytobezoar. After stabilization, she underwent surgical removal of the phytobezoar without complications and followed postoperative advice successfully. In cases without significant complications, surgical or aggressive medical treatment for bezoars may be unnecessary. Coca-Cola, alone or combined with endoscopic methods, is effective in dissolving gastric phytobezoars, with success rates exceeding 90%. Conservative management involves proteolytic enzymes, cellulase, carbonated beverages, and endoscopic fragmentation. Clinicians should stay vigilant, as small bowel obstruction can occur up to 6 weeks later. Prokinetic agents and dietary guidelines help minimize bezoar formation. Surgical intervention, unlikely to address the root cause and potentially worsening motility issues, requires careful consideration. Phytobezoars are a significant consideration in pediatric small bowel obstruction cases. Conducting a thorough dietary history, focusing on fiber-rich foods, is crucial. Radiographic and endoscopic studies aid in locating the phytobezoar. Timely surgical intervention is essential to prevent complications associated with small bowel obstruction.

Keywords: bezoar; case report; literature review; pediatric age group; phytobezoar; small bowel obstruction.

FIGURE 1

Computed tomography of abdomen showing phytobezoar (arrow shows phytobezoar). (A) Contrast enhanced axial section. (B) Plain axial section. (C) Contrast enhanced axial section. (D) Contrast enhanced coronal section.

FIGURE 2

Images showing phytobezoar. (A) Endoscopic view of the first part of duodenum. (B) Endoscopic view of the second part of duodenum (arrow shows phytobezoar). (C) Surgical removal under process (arrow shows phytobezoar). (D) Surgical removal completed (arrow shows phytobezoar).