Induced sepsis secondary to colonic phytobezoar: A rare case report

Abstract

Introduction: The word bezoar derives from the Persian term “padzahr” or from the Arabic term “badzehr,” both terms meaning antidote or antivenom. Bezoars are classified in trichobezoars, lactobezoars, pharmacobezoars, and phytobezoars, which constitute the most common type of bezoar. Bezoars are responsible for 0.4–4% of all cases of mechanical intestinal obstruction. Case Report: A 55-year-old female patient, who arrived at the emergency department, presenting intestinal obstruction characterized by the absence of evacuations and being unable to channel gasses with diffuse abdominal pain, nausea, and vomiting of five days of evolution. Only important antecedent was days prior to the interrogation of profuse intake of sunflower seeds. Abdominal X-ray showed distension of colonic loops, air-fluid levels, and an image compatible with coprostasis at sigmoid colon. Preoperative tests with neutrophilic leukocytosis with a white blood count of 27,000. Abdominal tomography showed the large bowel with abundant fecal material causing dilation of intestinal loops and abundant liquid in the pouch of Douglas. The patient underwent surgery where it was found a hyperemic and slightly phlegmonous sigmoid colon with thick content inside. Resection of the affected segment and primary colorectal anastomosis were performed. The extracted piece was opened with evidence of sunflower seeds, and was sent for histopathological study, where perforation was found. The patient was discharged five days after surgery with satisfactory evolution. Conclusion: Phytobezoars represent a very rare cause of intestinal obstruction, even more so in the large intestine. Bezoars should always be taken into account as a possible cause of intestinal obstruction.