Published in IJCP May 2018
Cotton Bezoar Causing Intestinal Obstruction
May 04, 2018 | Jagannath Kulkarni, Sanjiv Kumar Goyal, Girish Singla

Background: The unusual urge to eat cotton fibers is usually seen in people whose mental health is affected. Presentation could be in the form of trichophagy (eating hair), followed by trichobezoar or phytobezoar (eating vegetable fibers), which is a rare entity. Rapunzel syndrome is a term for trichobezoar where the parent bezoar is in the stomach and a tail of the fibers or hair extends into the jejunum. Presentation as gastric outlet obstruction due to a cotton bezoar in the stomach and intestine is rare, hence we report it here. Case report: A 60-year-old gentleman with no known comorbidities presented to the emergency room with history of pain abdomen, vomiting and loss of weight. Ultrasound followed by CT abdomen and pelvis revealed features of gastric outlet obstruction due to foreign body. On emergency exploratory laparotomy after initial resuscitation, he was found to have a large gastric cotton bezoar possibly extending into the proximal jejunum. The bezoar was extracted via gastrostomy and on-table enteroscopy confirmed complete evacuation of the bezoar. On postoperative Day 5, patient was discharged on soft diet. Conclusion: Gastrointestinal bezoars are a rare entity, and when cotton is the nature of bezoar with possible gastric outlet obstruction Rapunzel syndrome, it qualifies for inclusion into the literature.