Phytobezoar causing small bowel obstruction in a 4-year-old girl: a case report

Bezoar-induced small bowel obstruction is an uncommon condition. Its diagnosis is frequently difficult because of nonspecific symptoms, and surgical exploration remains the definitive treatment to restore bowel function and relieve the obstruction. A four-year-old girl with Down syndrome was admitted to the malnutrition ward due to failure to thrive since birth. She was diagnosed with severe acute malnutrition and started on appropriate management. On her second day, she developed repeated vomiting of ingested material mixed with grass, followed twelve hours later by progressive abdominal distension and inability to pass feces or flatus. Her vital signs showed a pulse of 126 bpm, respiratory rate 26/min, and temperature 37.4°C. Surgical consultation and abdominal radiography suggested small bowel obstruction. She was taken to the operating room, and exploratory laparotomy revealed a completely obstructing mass 40 cm from the ileocecal valve. An enterotomy was performed, and the bezoar was carefully removed. Other bowel segments were examined to rule out additional bezoars. Postoperatively, she remained stable and was transferred back to the malnutrition ward after two days. She continued nutritional management for two weeks and was discharged with significant improvement. Outpatient Department follow-up at two, four, and eight weeks revealed no new complaints. Her parents were counseled and she was discharged from the hospital. Bezoars should be included in the differential diagnosis of children who develop a small bowel obstruction. • Bezoar-induced small bowel obstruction is a rare but serious surgical emergency that often presents with nonspecific GI symptoms, making early diagnosis difficult. • Bezoars are concretions of indigestible material, with four types phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars each with specific risk factors. • Symptoms range from abdominal pain, bloating, and vomiting to severe complications such as obstruction, ulceration, hemorrhage, and bowel ischemia. • Early-stage bezoars may be treated conservatively, but surgical intervention via laparotomy and enterotomy is definitive, especially in obstructed or ischemic cases. • Prevention includes dietary changes, improving gastric motility, psychiatric follow-up, and close supervision to reduce recurrence in high-risk patients.