A massive colorectal lithobezoar in a 32-year-old woman.

A 32-year-old female patient with a history of iron deficiency and mental retardation, presented with chronic constipation and painful defecation related to a massive colorectal lithobezoar. She was successfully treated with laxatives and daily rectal enema.

CLINICAL IMAGE

A 32‐year‐old female patient with a history of iron deficiency and mental retardation, presented with chronic constipation and painful defecation for 1 month. Her parents reported also that she was eating stones for the last month.

On examination, she had an abdominal distension without a palpable mass. Digital rectal examination found several stony foreign bodies with watery stools.

The plain radiograph of the abdomen showed that both colon and rectum were entirely filled with radiopaque foreign bodies but with no air‐fluid levels (Figure 1A). The abdominal CT scan found also that colon and rectum were stuffed with hyperdense foreign bodies without bowel obstruction (Figure 1B,C,D).

FIGURE 1

A—Abdominal X‐ray showing colorectal massive filling with centimetric radiopaque foreign bodies. B,C,D—CT‐scan axial views showing giant lithobezoar of the entire colon E—Centimetric stones and a date nut evacuated by the patient thanks to rectal enema F—Abdominal X‐ray control (after 3 weeks of treatment) showing a subtotal clearing of the foreign bodies

Thanks to oral laxative and daily rectal enemas the patient evacuated almost all stones (varying in size from 1–3 cm) and other foreign bodies such as date nuts (Figure 1E). This was confirmed by an abdominal X‐ray control (Figure 1F).

Pica is a rare abnormal eating behavior of non‐nutritive substances. It is much more frequent in children than in adults. Apart from pregnancy, this type of geophagy may be observed in adults with mental retardation or with psychiatric pathology, in particular schizophrenia. A massive colorectal lithobezoar with intestinal obstruction as in our case is extremely rare in adults.

AUTHOR CONTRIBUTIONS

Houcem Harbi wrote the initial draft, reviewed the literature, revised manuscript, and approved the final version. Ahmed Bouzid reviewed the literature and approved the final version.

ACKNOWLEDGEMENTS

None.

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.

ETHICAL APPROVAL

Written informed consent was obtained from the patient parents. This case report did not receive any funding. The authors have access to all source data for this case report.

CONSENT

A written consent was obtained from the patient's next of kin (the patient has a mental retardation).