Chewing gum bezoar as an unexpected cause of acute intestinal obstruction

Abstract

An impaction formed of undigested foreign bodies or nutrients in the gastrointestinal tract is called a bezoar (Arabic: bazahr, Persian: padzehr, antidote). 1,2 Bezoars collected from animal stomachs were used as antidotes for poisons and therapies for numerous maladies, until Baudament in 1779 became the first to consider them as a cause of human disease. 1 A bezoar may occur at any part of the gastrointestinal tract, more frequently in proximal segments (stomach and duodenum). 3 The most familiar type is the trichobezoar (Greek: tricha, hair) of the stomach, occurring most commonly in patients younger than 30 years (80%), who are mainly (90%) young females who swallow their hair. 1,2 The phytobezoar type (Greek: phyto, plant) formed by vegetable fibre concretions is most commonly located in the small bowel of children. 2 Other types are caused by milk (lactobezoar), food boluses and medications (i.e. antacids). 1,3 Among the more uncommon causes of bezoar formation are candies, chewing gum included, with only a handful of cases reported in children.A 12-year-old female patient presented with acute abdominal pain and bile-stained vomiting. Abdominal plain radiography in upright position showed distended small bowel loops with airfluid levels (Fig. 1). A bolus of 300 mL of bilious content passed Key Points 1 In a child with gastrointestinal distress, do not omit to include swallowing and chewing habits in history. 2 It is a myth that bezoars occur mainly in mentally impaired children. The majority occur in healthy children. 3 The paediatrician should consult the parents on their child's swallowing and chewing habits and advise them to try to prevent their children swallowing candy or chewing gum.