EP112 - An Unusual Case of Seed Bezoars Intestinal Perforation

Abstract

Abstract Introduction Seed bezoars are a distinct subgroup of phytobezoars, caused by the accumulation of indigestible vegetable or fruit seeds in the intestinal lumen. Intestinal obstruction due to plant seeds is seldom encountered because of their relatively smaller size, and intestinal perforation is even rarer. Case Report We report a case of a 64-year-old hypertensive, diabetic and cardiac patient who came to surgical emergency department with generalized abdominal pain and vomiting for 3 days. She was tachycardiac, tachypneic and hypotensive at the initial presentation. Abdominal examination revealed tense, rigid abdomen with absent bowel sounds. Bilateral air under diaphragm was seen on an erect abdominal radiograph. Laboratory workup showed leukocytosis and metabolic acidosis. Laparotomy was performed after resuscitating the patient. Operative findings revealed gross contamination and gangrenous small bowel starting from about 8 feet distal to DJ flexure till 15 cm proximal to ICJ. There was a 2 x 2 cm perforation about 8.5 feet distal to DJ flexure secondary to obstructed seed bezoar (1 each of apricot, peach, and mango pickle seeds and 4 java plum seeds). Gangrenous small bowel was resected, and loop ileostomy was fashioned. She underwent cardioversion for ventricular tachyarrhythmias during the surgery. Post-operatively, she remained on ventilatory support in ITU but could not survive due to cardiac arrhythmias. Conclusion Although intestinal obstruction and perforation occur rarely due to phytobezoars, this should always be considered in the differential diagnosis, and early therapeutic intervention should be considered in morbid patients.