Large bowel obstruction due to sesame seed bezoar: a case report

Mango seed causing acute large bowel obstruction in descending colon-world's first reported case

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Phytobezoars are a rare cause of large bowel obstruction.

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It should be included in the differentials in patients with no specific symptoms and signs of colorectal cancers.

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Conservative and or Colonoscopic approach should be attempted first, in all patients with no signs of peritonitis.

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Patients who present in an acute setting with signs of peritonitis require laparotomy even when the diagnosis is a benign phytobezoar.

Introduction

Phytobezoars are a very rare cause of large bowel obstruction. Mango seeds as a phytobezoar causing large bowel obstruction have not been reported in the English literature.

Presentation of case

We present the case of a 69 years old female who presented to us with clinical and radiological signs of acute large bowel obstruction. On laparotomy, it was noted that mango seeds as a phytobezoar was responsible for the obstruction in the descending colon.

Discussion

Phytobezoars are a rare but known cause of small bowel obstruction. Large bowel obstruction is even rarer. The literature has documented a few cases of small bowel obstruction caused by mango seeds but none for large bowel obstruction. The most frequent reported sites of large bowel obstruction are the sigmoid colon and recto-sigmoid junction. However, phytobezoar causing descending colonic obstruction without any pre-existing underlying pathology has not been reported.

Conclusion

The association of bezoar with acute large bowel obstruction is a very rare however; it must be entertained in the differential diagnosis of any large bowel obstruction. Early diagnosis and treatment can avoid lethal complications. Our case being the first case of mango seeds phytobezoar in descending colon with acute large bowel obstruction; signifies its importance for reporting in the English literature.

Death Due to Complications of Bowel Obstruction Following Raw Poppy Seed Ingestion

Eating poppy seeds can cause a positive urine drug screen, but it is unknown whether ingesting large quantities can result in opiate intoxication or toxicity. A 54-year-old woman with intractable vomiting was found unresponsive at home and later pronounced dead. At autopsy, a cast-like large bowel obstruction composed of poppy seeds was identified. Postmortem blood morphine level was < 10 ng/mL. Cause of death was determined to be complications of a bowel obstruction secondary to poppy seed ingestion. Deaths related to eating poppy seeds have not been described in the literature. This case illustrates that consuming raw poppy seeds in large quantities did not cause lethal opiate toxicity. However, overdose deaths associated with ingesting poppy seed tea (PST) have been described. Poppy seed derivatives should be considered a potential source in cases of opiate toxicity without evidence of prescription or street drug abuse.

Case report: Colonic bezoar due to Box Myrtle seeds: A very rare occurrence

Large bowel seed bezoars are rare and are mostly due to seeds of sunflower, prickly pear cactus, sesame and cucumber. We present a rare case of sigmoid colon seed bezoar due to Box Myrtle seeds because of an underlying benign stricture.