Colonic phytobezoar

A healthy 51-year-old man presented to the emergency department owing to a lack of bowel movement and dull abdominal pain for 1 week. He had no history of any systemic illness. Physical examination disclosed hypoactive bowel sound and a 4-cm palpable mass over the left lower quadrant. A rectal examination was normal. Unenhanced computed tomography of the abdomen and pelvis disclosed a heterogeneous intraluminal mass, measuring 4.8 cm, with a mottled gas pattern impacted at the rectal–sigmoid junction (fig 1, arrow). Under rigid sigmoidoscopy, the bezoar was fragmented by a polypectomy snare. The follow-up barium enema was normal and the patient made an uneventful recovery.

Figure 1. Multidetector-row computed tomography of the abdomen and pelvis disclosed a heterogeneous intraluminal mass, measuring 4.8 cm, with a mottled gas pattern (arrow) impacted at the rectal–sigmoid junction.

Bezoar formation often combined gastrointestinal stasis and ingestion of non-digestible food material. The characteristic computed tomography finding of gastrointestinal bezoars is an intraluminal mass containing a mottled gas pattern.¹ As 20% of patients had recurrent bezoars, avoiding causative foods as well as proper mastication and adequate water intake would probably be beneficial.