Beyond usual suspects: phytobezoar in pediatrics a diagnostic challenge case report

Introduction and importance: Bezoars are rare masses of indigestible material that accumulate in the gastrointestinal tract. The clinical presentation varies depending on the location and severity of the obstruction. Their true incidence remains unknown. Case presentation: A 17-year-old female adolescent with a history of dysfunctional home environment and chronic eating disorder presented with atypical, persistent abdominal pain and oral intolerance. Despite multiple diagnostic studies, including a diagnostic laparoscopy with no pathological findings, her condition progressively worsened, leading to septic shock. An emergency laparotomy revealed a terminal ileum perforation caused by a foreign body identified as a phytobezoar. Clinical discussion: This case highlights the diagnostic challenge of bezoars due to their nonspecific symptoms. Although computed tomography is the preferred imaging method, it may not be conclusive, as phytobezoars radiolucent nature may resemble fecal small bowel contents on CT scans. Conclusion: Bezoars should be included in the differential diagnosis for patients with atypical and persistent abdominal pain, even after multiple negative diagnostic tests. A high index of suspicion is crucial in patients with erratic symptoms or psychosocial risk factors.