Phytobezoar induced small bowel obstruction mimicking intussusception in early infancy a case report and literature review

Abstract Background Phytobezoars represent an uncommon etiology of mechanical intestinal obstruction in the pediatric population, particularly among infants with no history of gastrointestinal surgery. The clinical presentation often mimics more prevalent surgical emergencies, such as intussusception, leading to diagnostic ambiguity. We report a case of complete ileal obstruction caused by a phytobezoar in a 9-month-old infant and provide a focused review of previously reported pediatric cases to contextualize the epidemiology, diagnostic characteristics, and management outcomes. Methods A focused (narrative) literature search of major electronic databases was performed to identify published reports of confirmed phytobezoar-induced intestinal obstruction in children (0–18 years), with particular attention to the neonatal and infant subgroup (≤ 2 years). Data regarding patient demographics, dietary etiology, anatomic location, imaging findings, therapeutic interventions, and outcomes were extracted and summarized, and were interpreted alongside the clinical details of the present case. Results The index case involved a 9-month-old male presenting with bilious vomiting and abdominal distension, in whom ultrasonography demonstrated a target-like lesion with an incomplete pseudokidney appearance mimicking intussusception. Surgical exploration revealed a phytobezoar composed of impacted vegetable fibers obstructing the distal ileum, present as a single large mass that fragmented during extraction, which was successfully removed via enterotomy with an uneventful recovery. Together with 10 previously published reports (11 sources in total), 46 pediatric patients were summarized. A bimodal age distribution was observed, with a distinct cluster of infant cases associated with foods such as grapes, potato, and other vegetable matter, independent of the persimmon-related bezoars more commonly reported in older children. The terminal ileum was the most frequent site of impaction. Operative management, most commonly via enterotomy, predominated across the reviewed literature. Conclusion Phytobezoar obstruction is a rare but important differential diagnosis in infants presenting with small bowel obstruction, even in the “virgin abdomen.” Diagnostic imaging may be inconclusive or misleading; therefore, a high index of suspicion is required. Early surgical exploration is definitive and curative, with excellent prognosis following timely intervention. Dietary counseling regarding introduction of high-fiber foods in early infancy may help prevent recurrence.