Infrequent cause of small bowel obstruction in a child: A lemon

Small bowel obstruction in children induced by phytobezoar impaction is reported here. Bezoars are classified into four types: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. We present here the first case of lemon shelves induced by small intestinal obstruction without previous gastrointestinal surgery and diagnosis was made erect abdominal x-ray.

We present a case of a three-year-old boy who presented with a history of abdominal pain, distension, and bilious vomiting, for the preceding one week. The child had no previous history of gastric or intra-abdominal surgery. The definitive diagnosis was not known before the operation. The case was diagnosed at laparotomy and removed through a distal enterotomy.

In surgical practice, small bowel obstruction is a prevalent problem. Phytobezoar is a rarely mentioned cause of mechanical small intestine obstruction, accounting for only 0.4-4% of all cases. The lemon shelves measuring 35 cm and 75 cm had impacted the terminal ileum of our patient, causing an obstruction that could only be discovered after an enterotomy as it was not feasible to be fragmented and milked into the cecum and an open appendectomy was performed because of the socio-economic reason.

The total bowel obstruction is treated with both laparotomies and milking through the ileocecal junction or enterotomy and direct extraction.