Multiple Gastrointestinal Bezoars- An Unusual Cause of Perforation Peritonitis

Introduction: Metal bezoars are rare forms of bezoar usually found in stomach but may be found anywhere in gastrointestinal tract. This condition is often seen in psychiatric patients and can even present with perforation peritonitis. Only a few case reports of large metal bezoars have been reported till date. Case presentation: An 18-year-old gentleman with psychiatric illness, presented to the emergency department due to hollow viscus perforation peritonitis after intentionally ingesting multiple foreign bodies (metal bezoars). There was a history of head injury 2 years ago resulting in disturbed mental status. Plain Radiograph of chest (erect view) showed multiple metallic objects with dilated stomach and free air under diaphragm. Emergency exploratory laparotomy with gastrotomy and primary repair of gastric perforation was performed and post-operative period uneventful. Conclusion: Metal bezoars have been associated with several gastrointestinal complications. Early diagnosis and treatment are important for prevention of morbidity and mortality. Although emergency exploratory laparotomy is the treatment of choice in case of perforation peritonitis, pharmacotherapy and behavioral assessment play vital role in overall care of patient to prevent recurrence.