eP102 - Large Colonic Bezoar: Rare Case Presentation

Purpose/Background: Phytobezoars are impacted undigested or partially digested fiber masses obtained from plant materials. A common cause is a low-fiber diet which slows the motility of chyme through the digestive system. Other risk factors include dehydration, a sedentary lifestyle, certain medications, vagotomy, peptic ulcer disease, gastritis, inflammatory bowel diseases, carcinoma, and diabetes mellitus. Based on the size and location, symptoms may vary from abdominal distension, abdominal pain, nausea, vomiting, constipation, upper gastrointestinal bleeding, and in some cases, bowel obstruction. Bezoars may be excreted naturally or through medical management, in severe cases operative intervention is required. Bezoars are usually encountered proximal to the ileocecal (IC) valve, colonic bezoars are a rare occurrence as the bezoar must transverse the IC valve.Methods/Interventions: Case report of a Colonic Bezoar causing large bowel obstruction.Results/Outcomes: A 65-year-old male, with a history of hypertension, hyperlipidemia, diverticulosis, and lower back pain, presented with cramping abdominal pain for 4 days associated with constipation. The patient reported a recent history of vacation out of state noted for eating large amounts of meat and vegetables. The patient had a colonoscopy 1 week prior for similar symptoms and was found to have bezoar in his transverse colon. Endoscopic removal of the bezoar was unsuccessful. The patient received laxatives and had bowel movements before discharge. The patient was re-admitted to the hospital with constipation.
Imaging findings on a CT A/P revealed the presence of a 10.0 x 5.8 x 6.4 cm bezoar, which was found to be migrating through the mid-transverse colon. Repeat imaging showing the progression of bezoar to distal transverse colon/splenic flexure. The colon distal to the bezoar was collapsed with stool within the proximal colon, pericolonic fat stranding, and small amounts of free pelvic fluid. The patient underwent exploratory celiotomy and colotomy with the extraction of the bezoar.
On postoperative day 2, the patient had bowel movements and showed signs of improvement, tolerating oral intake without difficulty. The patient was discharged on postoperative day 5 with instructions to follow a low-fiber diet and avoid foods that may result in the formation of phytobezoars.Conclusion/

Discussion: Phytobezoars are a rare but significant cause of gastrointestinal obstruction, occurring in various locations such as the distal transverse colon as in this patient. Gastric and terminal ileum bezoars are the most commonly described but colonic bezoars are relatively uncommon. Previous studies have noted the cause of colonic presentation to be due to the consumption of persimmons and reduced gastrointestinal motility caused by beta blockers. In this case, the risk factors and cause of phytobezoar obstruction are unclear.
Bezoar treatment depends on the site of impaction and size and is typically conservative, but endoscopic removal, or surgery may be required in severe cases such as this one. This highlights the importance of considering phytobezoars in patients with abdominal pain, bloating, and constipation. Further exploration is needed to better understand the pathophysiology and management of phytobezoars in the distal transverse colon and other locations of the gastrointestinal tract.