Abstract
A 64-year-old gentleman presented with a 12-h history of right iliac fossa pain. On examination, the patient had a tender 8 × 6 cm mass in the right iliac fossa with localised peritonitis. The working diagnosis at this time was an appendix mass or caecal cancer. A computed tomography scan revealed the characteristic ‘bird's nest’ appearance of a bezoar. On further questioning, the patient confessed to regularly ‘binging’ on grapes. The patient described passing the mass and his symptoms completely resolved. This appears to be the only documented case of a bezoar affecting the ascending colon.
Keywords: Bezoar, Colon, Bowel obstruction, Peritonitis
Introduction
Bezoars are a rare cause of gastrointestinal obstruction and often associated with psychiatric illness [1]. They comprise ingested foreign materials that accumulate within the gastrointestinal tract and are classified by the materials they are composed of. Trichobezoars and phytobezoars are most common, composed of hair and vegetable matter, respectively. Less commonly, pharmacobezoars are accumulations of medicines and lactobezoars as a result of undigested milk in feeding babies [2].
This report describes a case of an obstructing phytobezoar in the ascending colon. The case is illustrated clearly with a coronal computed tomography (CT) image (Fig. 1).
Fig. 1.
A coronal CT view of the abdomen and pelvis showing the typical bird's nest appearance of bezoar
Case
A 64-year-old man presented with a 12-h history of right iliac fossa pain. There was no change in bowel habit, no nausea, no vomiting, and no preceding history of trauma.
On examination, the patient had a tender palpable 8 × 6 cm mass in the right iliac fossa with localised peritonitis. The hernial orifices were intact and digital rectal examination was unremarkable. The working diagnosis at this time was an appendix mass or caecal cancer.
A plain abdominal film demonstrated a radio-dense shadow in the ascending colon with faecal loading proximally. A CT scan revealed the characteristic ‘bird's nest’ appearance of a bezoar.
On further questioning, the patient confessed to regularly ‘binging’ on grapes. As his pain settled and he had multiple co-morbidities, the decision was made to adopt conservative management. He was discharged home with the view to perform an outpatient colonoscopy. The patient described passing the mass soon after discharge, thus declining further investigation. He is now entirely symptom-free.
Discussion
Bezoars are mainly found proximal to sphincteric narrowings of the gastrointestinal tract, most commonly the stomach, followed by the small intestine [3]. Obstructing bezoars of the large bowel are rare and this appears to be the only documented case involving the ascending colon.
References
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