Lithobezoar: A rare case report
Masood-ur-Rehman, Adnan Mehraj and Abid hussain Dar
Department of Surgery H.H sheikh khalifa Bin zayed Al nahayan hospital/A.K CMH Muzaffarabad Azad Jammu and Kashmir
: Androl Gynecol: Curr Res
Abstract
Bezoar is defined as the accumulation of undigested foreign bodies or nutrients in the gastrointestinal tract. These foreign bodies can be hair (trichobezoar), fibers or seeds of vegetables and fruits (phytobezoar), or remnants of milk (lactobezoar), undigested medicine (pharmacobezoar) and stones (lithobezoar). Lithobezoar, the accumulation of stones in the digestive tract, is commonly seen in stomach. Primary colonic bezoar is an exceptionally rare situation. In this paper, a 33-years-old married lady with colonic lithobezoar who presented with generalized pain abdomen, vomiting multiple episodes, anorexia, absolute constipation, bleed per rectum one time and the history of pica was successfully treated by the extraction of the stones under general anesthesia. Discussion: Bezoar is accumulation of undigested foreign bodies or nutrients in the gastrointestinal tract .These foreign bodies can be hair (trichobezoar), fibers or seeds of vegetables and fruits (pythobezoar), or remnants of milk (lactobezoar) and stones (lithobezoar). The various non food items include amylophagia (laundry starch, corn starch), geophagia (clay, sand and dirt), lithophagia (stones, gravel and pebbles), pagophagia (ice), trichophagia (hair) and coprophagia (feces) . Until 2004 the number of cased reported in literature are twelve ,of which only three had colonic lithobezoars. only four colonic lithobezoars had been reported in the literature till 2007. bezoars is rarely seen in colon but stomach is the predilection site. Colonic lithobezoar can be seen as a result of pica . Pica is characterized by persistent craving and compulsive eating of nonfood substances such as clay or soil, ice, and stone. The etiology of pica is multifactorial including iron deficiency anemia, mental retardation, poverty, pregnancy, traditional eating habits, parental neglect, and low socioeconomic status. Pica has been reported to be associated with severe iron deficiency anemia in up to half of patients; however, it is unclear whether pica causes or is the result of iron deficiency anemia . They may present with the sign and symptoms of the bowel obstruction .on abdominal examination a palpable abdominal mass may be found on rectal examination “colonic crunch sign “ may be found .colonic crunch means the palpation of the prickly mass in the rectum. It is important to have plain abdominal radiograph in the diagnosis of any kind of suspected intraluminal colonic mass. The scattered radio opaque nature is typical of lithobezoar. It also has a unique picture on the plain abdominal radiograph known as ‘corn on the cob”.Anal dilatation under general anesthesia also helps in the dislodgement of the mass. Conclusion: We conclude that litho bezoar due to pica is not a rare disease now a days and they may lead to number of life threatening complications if ignored. This disease can be managed by conservative measures but if the complications occur then surgical intervention may needed. Lastly these patients should be kept on strict follow up and psychiatric assessment. The single most important factor which is to be considered to decrease the incidence of this disease is strict parental supervision.
Biography
Masood ur rehman born on 14th Jan 1986 in Muzaffarabad Azad Kashmir Pakistan. I am graduated from the medical school in March 2011. I passed my entrance exam of fellow ship in surgery from college of physician and surgeon Pakistan in 2012. Now I am in 3rd year of my residency .I passed membership exam of royal college of surgeon Edinburgh in 2015. I participated in number of conferences across the Pakistan attended multiple workshops .I am working on multiple research papers in Pakistan .My aim is to be the best surgeon and researcher of the world so that I make my parents and country proud
