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Table of Contents   
CASE REPORT
Year : 2020  |  Volume : 25  |  Issue : 2  |  Page : 103-105
 

Giant colonic lithobezoar: A rare case report


Department of Paediatric Surgery, IGICH, Bengaluru, Karnataka, India

Date of Submission05-Feb-2019
Date of Decision21-Mar-2019
Date of Acceptance13-Apr-2019
Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Jayalaxmi Shripati Aihole
Department of Paediatric Surgery, IGICH, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_24_19

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   Abstract 


Bezoar is defined as the accumulation of undigested foreign bodies or nutrients in the gastrointestinal tract. Lithobezoar, the accumulation of stones in the digestive tract, is commonly seen in the stomach. We report a case of giant colonic lithobezoar in a child.


Keywords: Bezoar, colorectal, lithobezoar, pica


How to cite this article:
Aihole JS. Giant colonic lithobezoar: A rare case report. J Indian Assoc Pediatr Surg 2020;25:103-5

How to cite this URL:
Aihole JS. Giant colonic lithobezoar: A rare case report. J Indian Assoc Pediatr Surg [serial online] 2020 [cited 2020 Feb 22];25:103-5. Available from: http://www.jiaps.com/text.asp?2020/25/2/103/276941





   Introduction Top


Colonic lithobezoar is rare in children more so in adults. It is commonly associated with a history of pica. Pica is an eating disorder characterized by persistent ingestion of nonnutritive substances. Colonic lithobezoar usually presents with mechanical large bowel obstruction.[1],[2],[3],[4],[5],[6],[7],[8]


   Case Report Top


A 5-year-old male child presented to us with a history of diarrhea associated with passing of stones in the stools for 3 days. The child did not have any vomiting, pain abdomen, or fever. The child was taken to a local doctor, where abdominal radiography was done, suggestive of giant colonic lithobezoar [Figure 1]a and hence referred to our institute. On examination, the child was stable and cooperative, abdomen was soft without distention or tenderness, and per-rectal examination revealed crenated stony feel. He was admitted and tap water enemas twice daily were started. Subsequently, he passed stones in the stools of sizes varying from 5 mm to 2.4 cm following enemas [Figure 1]b and [Figure 2]a. The child was observed closely in the hospital till abdominal radiography revealed clearing of the stones [Figure 2]b. Meanwhile, on evaluation, the baby's hemoglobin was found to be 7 gm%; hence, nutritionist's opinion was taken and started on oral hematinics. The child's psychiatric evaluation was found to be normal. He was followed with daily tap water enemas and was discharged after 4 days uneventfully and successfully without requiring any anesthesia or surgical interventions.
Figure 1: (a) Plain abdominal radiography – giant colonic lithobezoar and (b) plain abdominal radiography – after partial clearance of lithobezoar

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Figure 2: (a) Manually evacuated as well as spontaneously passed lithobezoar, (b) plain abdominal radiography – after clearing of giant colonic lithobezoar

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   Discussion Top


Pica is persistent eating of nonnutritive substances and is common in children. The cause of pica is unknown, but multifactorial etiology has been suggested. Iron deficiency anemia and underlying psychiatric illness have been suggested as one of the etiologies. Bezoars may be composed of hair (trichobezoars), vegetable matter (phytobezoars), milk curds (lactobezoars), sand bezoar, and very rarely, stones (lithobezoars).[1],[2],[3],[4],[5],[6],[7],[8]

Clinically, these children often present with signs and symptoms of mechanical bowel obstruction. A palpable abdominal mass occasionally found. On rectal examination, the presence of the “colonic crunch sign” can increase the suspicion of bezoar obstruction.[2],[3],[4],[5],[6]

The scattered radiopacities on routine abdominal radiography are typical of lithobezoar and called as “corn on the cob appearance” [Figure 1]a.[1],[2],[3],[4],[5],[6],[7],[8]

As per our literature search, we found seven cases which were managed by manual evacuation of the stones under general anesthesia.[1],[2],[3],[4],[5],[6],[7] Aihole reported two additional cases in September 2018, of colonic lithobezoar where both cases were managed successfully by daily tap water enemas without requiring general anesthesia or any surgical interventions [Table 1].[8]
Table 1: Colonic lithobezoar in children overview of literature

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A single case of giant colonic lithobezoar has been reported by Sheikh et al. in a 9-year-old male child, managed by manual evacuation under general anesthesia.[6] Similarly, in our institute, a case of giant colonic lithobezoar in a 5-year-old male who presented to us with a history of diarrhea and passing of stones in the stools was managed expectantly by regular enemas and nutritional support under close observation, in the hospital.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

Author would like to thank all the paediatric surgical colleagues of IGICH, Bengaluru, Karnataka, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Vijayambika K. Lithobezoar. Indian Pediatr 2004;41:1168.  Back to cited text no. 1
    
2.
Tokar B, Ozkan R, Ozel A, Koku N. Giant rectosigmoid lithobezoar in a child: Four significant clues obtained from history, abdominal palpation, rectal examination and plain abdominal X-ray. Eur J Radiol Extra 2004;49:23-4.  Back to cited text no. 2
    
3.
Narayanan SK, Akbar Sherif VS, Babu PR, Nandakumar TK. Intestinal obstruction secondary to a colonic lithobezoar. J Pediatr Surg 2008;43:e9-10.  Back to cited text no. 3
    
4.
Numanoǧlu KV, Tatli D. A rare cause of partial intestinal obstruction in a child: Colonic lithobezoar. Emerg Med J 2008;25:312-3.  Back to cited text no. 4
    
5.
Mohammad MA. Rectosigmoid lithobezoar in a eight-year-old. Afr J Paediatr Surg 2010;7:38-9.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Sheikh MS, Hilal RM, Misbha AM, Farooq AR. Colorectal lithobezoar: A rare case report. J Indian Assoc Pediatr Surg 2010;15:62-3.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Senol M, Ozdemir ZÜ, Sahiner IT, Ozdemir H. Intestinal obstruction due to colonic lithobezoar: A case report and a review of the literature. Case Rep Pediatr 2013;2013:854975.  Back to cited text no. 7
    
8.
Aihole J. Colonic lithobezoar: Our experience in children. J Paediatr Child Health 2018;54:1042-4.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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