Phytobezoar caused by ingestion of air cooler husk in a 6-year-old boy: A case report

Abstract

Introduction

Bezoars are conglomerates of indigestible material that accumulate in the gastrointestinal tract. Phytobezoars, derived from plant matter, are the most common type.

Case presentation

A 6-year-old boy presented with a one-week history of severe continuous abdominal pain, projectile vomiting, and constipation. He had experienced intermittent abdominal pain over the preceding three months, temporarily relieved by over-the-counter medications. Despite being well-developed, the child had a habit of chewing air cooler husk strips. Physical examination revealed a firm mass in the epigastrium extending to the right hypochondrium. An erect abdominal X-ray showed a distended stomach, without any distal obstruction. Abdominal ultrasound identified a mass with posterior shadowing, suggestive of a bezoar. Computerized tomography (CT) of the abdomen confirmed a mottled, heterogeneous mass in the stomach. The patient underwent an upper gastrointestinal endoscopy that confirmed a bezoar composed of air cooler husks, extending into the lower esophagus, but endoscopic removal was unsuccessful. The patient underwent a laparotomy and through an anterior gastrotomy we entirely removed the bezoar. The gastric wall had no signs of pressure necrosis or ulceration. The stomach was closed in 2 layers with running sutures. The patient recovered uneventfully. He remained nil per os (NPO) for 5 days, resumed oral feedings on the 6th postoperative day, and was discharged home on the 7th postoperative day having regular bowel movements and tolerating his diet well.

Conclusion

Phytobezoars must be included in the differential diagnosis of children with recurrent abdominal pain, particularly those with abnormal eating habits.