Harry Potter's Occlusion: Report of a Case of Pumpkin Seed Bezoar Rectal Impact

Abstract

Bezoar is a term from Arabic “bāzahr” or ultimately from Middle Persian “p'tzhl” (pādzahr, “bezoar antidote” or less commonaly ægagropile or egagropile (2–4). It was believed to have the power of a universal antidote that works against any poison, and a glass containing a bezoar could neutralize any poison poured into it. In science, it is a mass of hair or undigested vegetable matter found in a human or animal intestines, similar to a hairball. Otherwise, the name could derive from a kind of Turkish goat whose name is just bezoar. Usually, it is found trapped in every part of the gastrointestinal system and must be distinguished by pseudobezoar, which is an nondigestible object voluntarily introduced into the digestive tract. The most common causes are a previous gastric surgery such as a gastric band (for weight loss) or gastric bypass, a reduced stomach acid (hypochlorhydria) or decreased stomach size, and a delayed gastric emptying, typically due to diabetes, autoimmune disorders, or mixed connective tissue disease. Seed bezoars are usually found in the rectum of patients without predisposing factors, causing constipation and pain. Rectal impaction is common after ingestion of seeds, while a true occlusion is rare. Although several cases of phytobezoars composed of various types of seeds are reported in the literature, bezoars of pumpkin seeds have rarely been reported. The authors report a case of fecal impaction by pumpkin seed bezoars with abdominal pain: a difficulty to void with subsequent rectal inflammation and hemorrhoid enlargement was observed. The patient underwent a successful manual disimpaction.

Seeds of Discomfort: An Unusual Case of Pediatric Abdominal Pain

“…Similar to our patient, the most common presenting symptoms of rectal seed bezoars are constipation followed by abdominal/rectal pain [ 2 ]. The typical treatment includes fecal disimpaction, either manually or surgically, with less success with chemical dissolution (e.g., Coca-Cola) compared to fiber bezoars [ 7 ]. When reported, cases of rectal seed bezoars typically focus on diagnosis and treatment, with few documented complications.…”

Pelvic Radiation Disease

“…14 Surgery is usually reserved for patients with highly significant and debilitating bleeding, stricture, or fistula (see below) due to very high morbidity and mortality rates. 11 The ideal surgical approach, in particular the question of simple diversion versus formal resection, remains unclear.…”

“…Formalin 4% topical instillation is also effective (arguably more so) but associated with a higher risk of significant local complications. 10 11 Its use is typically reserved for the treatment of larger areas of proctitis where serial APC application has failed. Other medical treatments such as sucralfate enemas and oral antibiotics are considered potential adjuncts but are not in common use in clinical practice.…”

Seedy Business: A Pumpkin Seed Bezoar

“…Pumpkin seeds and sunflower seeds are readily available year-round in the United States. Few case reports specifically describe pumpkin seed bezoars, [2][3][4][5][6][7] with only two case reports identified in the US. 3,4 Bezoars can occur anywhere in the gastrointestinal tract, but they are typically found in the stomach.…”