A rare case of acute large bowel obstruction due to colonic bezoars associated with pica in a pediatric patient: A case report.

INTRODUCTION

Colonic bezoars are undigested or partially digested materials that accumulate in the form of a mass in the colon. There are occasional reports of constipation and intestinal obstruction due to geophagia or pica. Bezoars are due to pica, which is commonly associated with iron deficiency anemia and psychiatry disorders.

CASE PRESENTATION

A nine-year old female child presented with complaint of abdominal pain, vomiting and constipation for few months, and lately with features anemia and acute intestinal obstruction. She had history of pica. After evaluation she was treated surgically in two stages. In the first stage exploratory laparotomy with evacuation of lithobezoars with transverse colostomy was done, which was followed by colostomy reversal in the second stage. As a part of multidisciplinary treatment, psychiatric counseling and nutritional support were provided.

DISCUSSION

Colonic lithobezoars presenting with features of chronic constipation and complicated with large bowel obstruction is a rare finding. Diagnostic imaging modalities such as X-ray and CT scan play an important role in confirming the diagnosis. Initial management involves conservative measures for uncomplicated cases with surgical intervention as a definitive option for complications like obstruction or perforation.

CONCLUSION

This case highlights the importance of considering pica with bezoars in children presenting with anemia and features of bowel obstruction. In such case multidisciplinary support and definitive medical and surgical management is done.