Case Report A Novel Case of Malabsorption and Melena in an adolescent boy: Trichobezoars and Multiple Magnet Ingestion

Abstract

ABSTRACT

Bezoars are collections of non-specific, indigestible elements in the stomach and intestines. In children, bezoars are an uncommon cause of gastrointestinal bleed and obstruction, rarely malabsorption.

We are reporting an unusual case of bezoar formation in an 11-year-old, previously healthy, but developmentally delayed child. He was referred to the Department of Pediatric Gastroenterology at Children Hospital Faisalabad, with a history of intermittent diarrhea, vomiting, and body swellings. He also had a history of progressive pallor along with melena, for which he got multiple blood transfusions. Investigations ruled out nephrotic syndrome, celiac disease, IBD, intestinal obstruction, abdominal TB, pancreatitis, and liver disease prior to the referral. A detailed workup showed multiple metallic density foreign bodies in the small intestine on a plain X-ray of the abdomen. Endoscopy revealed ulcers in the esophagus and duodenum, as well as bezoar formation in the stomach and small intestine, consisting of several long, entangled structures comprising of hair and linen threads extending from the stomach beyond the duodenum and which could not be removed completely during endoscopy. The presence of fecal matter in the stomach raised suspicion of fistulous communication within the gut. The patient was referred to the pediatric surgery department, where exploratory laparotomy was done. A massive bezoar containing hair and fabric threads was removed. A bunch of 22 magnets was retrieved as well. We hope to highlight the significance of constantly observing developmentally delayed children, in addition to promoting awareness regarding trichotillomania, pica, magnet ingestion, and bezoar formation.