Large bowel obstuction by ingestion of multiple African star apple seed in a child with Hirschsprung disease

Abstract

Background: Intestinal obstruction caused by ingestion of plant seeds are uncommon in children. Most cases of intestinal obstruction following foreign body ingestion result from impaction by phytobezoars, which are mass formations of indigestible plant materials. The large bowel is an unusual site for obstruction except in individuals with a background gastrointestinal disorder, as most ingested foreign objects pass spontaneously out of the gastrointestinal tract. Ingestion of numerous plant seeds is rare in neurologically unimpaired children.
Aim: To report the uncommon occurrence of intestinal obstruction of the large bowel following ingestion of multiple African star apple seeds in an under-five boy with previously undiagnosed Hirschsprung disease.
Report: A 4-year boy presented to our Emergency ward with intestinal obstruction following ingestion of numerous African star apple seeds. An emergency exploratory laparotomy was performed which revealed gross distension of the caecum down to the sigmoid colon with impaction of numerous African star apple seeds. A loop transverse colostomy and rectal wall biopsy was done. He was discharged after 10 days with good recovery. Histology report was confirmatory of Hirschsprung disease.
Conclusion: Intestinal obstruction resulted from inadvertent ingestion of numerous African star apple seeds in a neurologically unimpaired child with a background Hirschsprung’s disease. Very young children should be supervised to prevent them from ingesting African star apple fruit to avoid unintended impaction/intestinal obstruction in the presence of an undiagnosed gastrointestinal disorder.