Not everything that obstructs is a tumor: the bezoar as a great colonial simulator. A case report.

Abstract

Bezoars are accumulations of indigestible material within the gastrointestinal tract and represent an uncommon cause of intestinal obstruction. Colonic obstruction due to bezoars is exceptionally rare and may mimic colorectal malignancy, making preoperative diagnosis challenging. We report the case of a 66-year-old man with no previous abdominal surgery who presented with abdominal distension, nausea, and a two-day history of obstipation. Contrast-enhanced abdominal computed tomography demonstrated diffuse colonic dilatation with an abrupt transition point and mural thickening at the sigmoid colon, initially suggesting an obstructing colorectal neoplasm. Retrospective review of the images identified two heterogeneous intraluminal masses consistent with bezoars. Flexible sigmoidoscopy was unsuccessful because of abundant fecaloid material obstructing endoscopic progression. Owing to persistent bowel obstruction, urgent exploratory laparoscopy was performed, revealing two intraluminal bezoars, one impacted in the sigmoid colon and the other located in the descending colon. Both bezoars were removed by colotomy, and a segmental sigmoid colectomy with primary anastomosis was performed. Histopathological examination identified both masses as trichobezoars. The postoperative course was uneventful. Trichobezoars are exceptionally uncommon in older adults, particularly when presenting as colonic obstruction without a history suggestive of trichophagia. This case highlights the importance of considering bezoars in the differential diagnosis of large bowel obstruction and emphasizes the role of contrast-enhanced computed tomography in guiding diagnosis and surgical management.

Keywords: bezoar, colonic obstruction, impaction.