Giant granadilla’s seeds phytobezoar rectal impactation: a very unusual case of intestinal obstruction

Abstract

A 78-year-old Caucasian man presented to the emergency department with bloody diarrhoea, diffuse abdominal pain and fever with 1-week duration. He had just returned from Angola where he had been treated for a presumed infection without improvement. He had no relevant medical or familiar history except for hypertension and prostate benign hyperplasia. He was drowsy, feverish and eupnoeic. His oxygen saturation on pulse oximetry was 92%, blood pressure was 173/99 mm Hg and pulse rate 100 beats per minute. Except for a distended, silent and painful abdomen, particularly on lower quadrants, the rest of the examination was unremarkable. A CT showed a mesh-like mass inside the rectum conditioning colonic obstruction and distention. This turned to be a giant granadilla's seeds phytobezoar and was removed endoscopically. Five days later, the patient had a colonic perforation requiring total colectomy. He made a full recovery after rehabilitation for 3 months.

Rectosigmoid transition perforation by ingá (Inga laurina) seeds in the Brazilian amazon: Case report and surgical treatment

“…Fruit/fruit intake is related to complications when there is no digestion of the seeds, with their accumulation and compaction forming a single object, known as phytobezoar [ 10 ]. Despite this, bezoar is more related to obstructive conditions of the proximal digestive tube, and rarely evolve to perforation [ 11 ].…”

“…The psychiatric and cultural aspect must be evaluated. Fruit seed bezoars such as jabuticaba or granadilla are reported in places with high consumption of these foods [ 10 , 11 ]. In the case reported here, there was no formation of bezoars, but an acute ingestion of ingá seeds ( Inga laurina species), probably due to the patient's regional costume, and not due to a psychiatric condition, different from trichobezoars [ 14 ].…”