Published in IJCP
May 2018
SURGERY
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.
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