Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2020  |  Volume : 25  |  Issue : 2  |  Page : 103--105

Giant colonic lithobezoar: A rare case report


Jayalaxmi Shripati Aihole 
 Department of Paediatric Surgery, IGICH, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Jayalaxmi Shripati Aihole
Department of Paediatric Surgery, IGICH, Bengaluru, Karnataka
India

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.



How to cite this article:
Aihole JS. Giant colonic lithobezoar: A rare case report.J Indian Assoc Pediatr Surg 2020;25:103-105


How to cite this URL:
Aihole JS. Giant colonic lithobezoar: A rare case report. J Indian Assoc Pediatr Surg [serial online] 2020 [cited 2020 Apr 10 ];25:103-105
Available from: http://www.jiaps.com/text.asp?2020/25/2/103/276941


Full Text



 Introduction



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



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}{Figure 2}

 Discussion



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}

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.

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