Colorectal bezoars as an unusual cause of intestinal obstruction in an autistic child: A case report

Introduction and importance: Individuals with Autism Spectrum Disorder (ASD) are at greater risk of experiencing co-occurring gastrointestinal (GI) symptoms, including chronic constipation and acute intestinal obstruction, due to bezoars secondary to pica. This case highlights the importance of clinic evaluation of autistic patients presenting with obstructive gastrointestinal symptoms and its further impact on management of the patients. Case presentation: An 11-year-old male patient who has had autism since childhood presented to the emergency department with chief complaint of difficulty in passing stool for one month which was associated with failure to pass flatus, severe abdominal pain and loss of appetite. The relative reported that the patient had a tendency of eating inorganic materials when unsupervised like hair, cushion sponges or sand. An abdominal mass was palpated at the left lower quadrant of the abdomen. Abdominopelvic CT-Scan showed fecal impaction. The patient was managed conservatively by manual evacuation under general anesthesia. Clinical discussion: Colonic bezoars presenting with obstructive symptoms is a rare finding. It should be thought of in autistic patients with habit of pica. Diagnostic imaging modalities such as X-ray and CT scan are of paramount importance in confirming the diagnosis. Initial management involves conservative measures for uncomplicated cases. Conclusion: Bezoars should be considered as cause of intestinal obstruction in patients with habit of pica, especially in those with autism spectrum disorders. Multidisciplinary approach to diagnosis, intervention, and long-term management in assuring patients' overall well-being should sought.