An Unusual Presentation of Crohn’s Disease Diagnosed Following Accidental Ingestion of Fruit Pits: Report of Two Cases and Review of the Literature

Abstract

The clinical course of Crohn’s disease (CD) is often complicated by intestinal strictures, which can be fibrotic, inflammatory, or mixed, therefore leading to stenosis and eventually symptomatic obstruction. We report two cases of subclinical CD diagnosed after fruit pit ingestion, causing bowel obstruction; additionally, we conducted a narrative review of the scientific literature on cases of intestinal obstruction secondary to impacted bezoars due to fruit pits. Symptoms of gastrointestinal bezoars in CD patients are not diagnostic; and the diagnosis should be based on a combined assessment of history, clinical presentation, imaging examination and endoscopy findings. This report corroborates the concept that CD patients are at a greater risk of bowel obstruction with bezoars generally and shows that accidental ingestion of fruit pits may lead to an unusual presentation of the disease. Therapeutic options in this group of patients differ from the usual approaches implemented in other patients with strictures secondary to CD.

Intestinal Obstruction Associated with Pharmacobezoar in a Patient with Crohn’s Disease: A Case Report

“…Recently, Wu and Chen [5] presented a management algorithm for handling bezoars and foreign bodies in individuals with inflammatory bowel disease (IBD). According to their proposal, if a patient experiences asymptomatic or partial small bowel obstruction accompanied by an inflammatory stricture, they recommend adopting a "wait and see" strategy coupled with medical treatment involving steroids.…”

“…These masses can be formed by different substances, which may be ingested either intentionally or accidentally. Some of the materials that can form bezoars include plant derivatives such as fibers, vegetable and fruit skins or seeds (known as phytobezoars), ingested hair (trichobezoars), and medications (pharmacobezoars) [5] [6].…”

Letter: fulminant‐onset complicated inflammatory bowel disease (IBD)—a unique subtype?

“…Patients can present with penetrating, 2 and/or stenotic 3 CD at diagnosis, even after only a few days or weeks of symptoms (i.e., short diagnostic delay). These patients are omitted from pharmaceutical trials, and may be excluded or missed (since sometimes they are only surgically managed) from IBD databases.…”