An unusual cause of intestinal obstruction: Plastobezoar

Abstract

Bezoars are usually present as a mass in the stomach. It is formed due to eating non-food items like hair (trichobezoar), vegetable matter (phytobezoar), and sand bezoar. There are many such cases reported in literature of bezoars but there very few cases of bezoar formed by plastic material. We report an unusual case of plastobezoar that was extending from the stomach to distal ileum, and the patient presented with features of intestinal obstruction. An 8-year-old female child was admitted with history of abdominal pain and constipation for 3 days. Her mother gave a history of ingestion of plastic fibers from mattress filled with plastic fibers by the patient. Abdominal examination revealed moderate distention and tenderness but with no features of peritonitis. Mental health assessment was performed by the psychiatrist and it did not reveal any gross abnormality. Following clinical examination, laboratory test and radiological imaging background, a diagnosis of intestinal obstruction due to bezoar was made. After proper resuscitation, laparotomy was performed and plastobezoar was removed from stomach and intestine through a gastrostomy and enterostomy respectively. Both stomach and intestine were primarily closed. Other abdominal viscera were normal. Abdominal cavity was closed in layers. Post operative period was uneventful. Patient was discharged in satisfactory condition. Early diagnosis of bezoar should be made by detailed history and psychiatric evaluation so that they can be treated endoscopically to avoid laparotomy and operative mortality.