Rectal sunflower seed bezoar in an 11-year-old: A case report

Sunflower seed bezoars are an indigestible mass created after consuming several unshelled sunflower seeds. We present the case of an 11-year-old who visited the emergency department with abdominal pain, constipation, and rectal bleeding. The rectal exam findings were consistent with a presumed stool ball. Symptoms persisted even after enema and polyethylene glycol administration. The patient was discharged, and after an attempted manual self-disimpaction at home, the patient's mother noted sunflower seed shell remnants in the stool. Upon further questioning, the patient endorsed consuming 10 ounces of salt and pepper-flavored unshelled sunflower seeds ~1 week before her first physician visit. Upon return to the emergency department, the patient underwent cross-sectional imaging, confirming the diagnosis of sunflower seed bezoar. Manual and instrumental disimpaction were performed under general anesthesia with symptomatic improvement. Seed bezoars should be considered for acute constipation refractory to laxatives in pediatric patients, especially after recent sunflower seed consumption.