An unusual cause of acute abdomen: Massive amounts of foreign-body bezoar

Abstract

Case Report introductionAggregates of undigested or partially digested materials that could be found within the body or more specifically within the gastrointestinal (GI) tract are known as "Bezoars." [1,2] Although more commonly found in the stomach, they can also be found in the small and large intestines or even less frequently in the rectum. [3] Bezoars are classified according to their composition into five types. In decreasing order of frequency, they are phytobezoars (composed of undigested vegetable fibers), [4] diospyrobezoars (a type of phytobezoars comprised persimmon fruit), [4] trichobezoars (associated with trichotillomania known as the Rapunzel Syndrome), [4,5] pharmacobezoars (also known as drug bezoars and made up of accumulated undigested medications; [4] ), and lactobezoars (made up of milk proteins and mucus. [4] Foreign-body bezoars could be anything from plastic to foams, metals, or even worms such as ascaris. [4] Only a few papers were published in the literature regarding foreign-body bezoars in large intestines that were linked to psychiatric patients, even less so, case reports of bezoars being administrated orally as well as rectally.Acute abdomen, especially in psychiatric patients, can result from bizarre causes such as bezoars. This unique case report intends to shed light on a rare type of bezoars with an unusual presentation. A 30-year-old schizophrenic male, who is in denial of his mental condition and having mystical believes instead, presented with acute abdomen. Workups revealed vast amounts of foreign bodies within dilated intestines. Exploratory laparotomy was done extracting about 2 kg of nylon-wrapped foreign bodies which caused distention with multiple perforations to both cecum and sigmoid colon. Interestingly, the foreign materials were either ingested or introduced rectally. Although bezoars are not a common finding nowadays. They should still be considered as a potential cause of acute abdomen in psychiatric and some nonpsychiatric patients alike, especially in countries, where mental illness can easily be disguised as mystical beliefs.