Huge plastic bezoar: a rare cause of gastrointestinal obstruction

Bezoars are rare causes of gastrointestinal obstruction. Basically, they are of four types: trichobezoars, phytobezoars, pharmacobezoars, and lactobezoars. Some rare types of bezoars are also known. In this article a unique case of plastic bezoars is presented. We describe a girl aged 14 years who ingested large amounts of plastic material used for knitting chairs and charpoys. The conglomerate of plastic threads, entrapped food material and other debris, formed a huge mass occupying the whole stomach and extended into small bowel.


Introduction
Bezoars are rare causes of gastrointestinal obstruction. They mostly originate in the stomach, and occur mainly in patients with psychiatric ailments who chew and swallow their hair (trichobezoar), vegetable fibres (phytobezoar), persimmon fibres (diospyrobezoar), or tablets/semi liquid masses of drugs (pharmacobezoar). Industrial materials including wood trashes, polystyrene, plastic have been reported as the rare causes of bezoar formation. In this report, we describe a 14-year-old girl who developed obstructing Plastic bezoars of both the stomach and small intestine and literature review.

Discussion
The word bezoar is a word derived from the Arabic "bazahr" or "badzehr" which means an antidote or counter-poison. Till the 19 th century, bezoars obtained from sacrificed animals had been widely used as antidote [1].
Bezoars are the uncommon result of ingestion of poorly digestible or indigestible substances. Trichobezoars and phytobezoars are the two most common bezoars described in literature. Other unusual bezoars are pharmacobezoars, lactobe-zoars, metal bezoars, plastic bezoars, and sand bezoars. Trichobezoars are found in teenagers, especially in female patients with psychiatric problems.
Phytobezoars are found more frequently and are incarcerated foodstuffs not digested in the intestine [1,2]. Plastic bezoars are also rare, resulting from the ingestion of plastic material, especially by mentally retarded patients. The case in discussion had swallowed a large amount of plastic material and since plastic cannot be digested, a bezoar formed in the stomach, and the long strings extend down to the duodenum and intestines, leading to Rapunzel syndrome [3].
Predisposing factors to bezoars, in addition to dietary behaviour, include previous gastric surgery, particularly partial gastrectomy or truncal vagotomy with pyloroplasty. In adults, bezoars are most frequently encountered after gastric operations. In children they are associated with pica, mental retardation, psychiatric disorder and coeliac disease [3,4]. Bezoars are usually found in the stomach but may also be found in the duodenum, ileum, jejunum, colon or Our patient had a unique bezoar due to eating disorder in which he was eating plastic material used for knitting chairs and charpoys.
This abnormal eating disorder of plastikophagia has been reported earlier too [5].
Patients usually present with recurrent vomiting, abdominal pain, and sometimes lump in the abdomen. The diagnosis often can be made on the basis of findings of conventional radiography and barium studies. On plain abdominal radiography, we found an Page number not for citation purposes 3 opaque bezoar, which formed a perfect cast of the stomach. CTscan could demonstrate a well-defined round mass which could be outlined by stomach or the bowel wall and present characteristic internal gas bubbles of bezoars [6].
Endoscopic investigations could show all of gastric bezoars. Bezoars located in the esophagus or stomach should be treated conservatively in the first instance. Surgery is recommended in cases with massive and non-progressive foreign bodies, or complicated cases presenting with perforation, penetration, hemorrhage, or obstruction [3,7].

Conclusion
Plastic bezoars are rare causes of gastrointestinal obstruction, resulting from the ingestion of plastic material, especially by mentally retarded patients. Surgery is recommended in cases with massive and non-progressive foreign bodies, or complicated cases.