Intestinal Obstruction due to Colonic Lithobezoar: A Case Report and a Review of the Literature

Bezoar is defined as the accumulation of undigested foreign bodies or nutrients in the gastrointestinal tract. These foreign bodies can be hair (trichobezoar), fibers or seeds of vegetables and fruits (phytobezoar), or remnants of milk (lactobezoar) and stones (lithobezoar). Lithobezoar, the accumulation of stones in the digestive tract, is commonly seen in stomach. In this paper, a 7-year-old girl with colonic lithobezoar who presented with constipation, abdominal pain, and the history of pica was successfully treated by the extraction of the stones under general anesthesia. 1. Introduction Colonic lithobezoar is a rare disorder and may cause mechanical intestinal obstruction in children [1]. It is mostly seen in patients with the history of iron deficiency anaemia and pica. Pica is an eating disorder typically defined as the persistent ingestion of nonnutritive substances [2]. We report a case of colonic lithobezoar in a child who was successfully evacuated under general anesthesia. 2. Case Report A 7-year-old girl was admitted to the emergency room with abdominal pain and constipation. She had an absence of defecation for the past 3 days. In her medical history, she was treated for iron deficiency anaemia and she had the compulsive behavior of pica. Her vital parameters were normal and her general physical examination results were unremarkable. Abdominal examination revealed distention and mild tenderness with no signs of peritonitis. Irregular masses in the left lower quadrant of the abdomen were palpated. Rectal examination demonstrated hard masses like fecaloids. Some of these masses were extracted and they turned out to be stones along with stool. The laboratory studies revealed hemaglobin 6.8？g/dL, hematocrit 22.5%, MCV 53.4？fL, ferritin 9.0？ng/mL, iron 14？mg/dL, and iron binding capacity 415？mg/dL, pointing out an iron deficiency anaemia. Abdominal X-ray demonstrated radioopaque masses of various sizes in the distal colon. There was no noticed air-fluid level (Figure 1). Figure 1: Abdominal X-ray. Along these results, the diagnosis of intestinal obstruction due to lithobezoar was made. Under general anesthesia, following anal dilatation, manual evacuation, and colonic lavage were done. Approximately 2 kilograms of stones in various sizes were extracted (Figure 2). She was followed up with abdominal X-ray and laboratory tests postoperatively. She continued to pass out stones till the postoperative second day. On the postoperative third day, her abdominal X-ray revealed no stones in the colon and no signs of colonic obstruction and perforation,