Khat induced bezoar; a rare cause of small bowel obstruction:a case report

Introduction: Bezoar-induced small bowel obstruction (sbo) is a rare entity that might be difficult to establish diagnosis preoperatively. There are a multitude of factors attributed to its occurrence in different literature. Khat chewing which is widely practiced in eastern African and Middle East countries might contribute directly or indirectly to bezoar formation. It has chemicals known to decrease bowel motility thereby, possibly leading to concretion of proximal gastrointestinal contents. The aim of this case report is to give emphasis on the effect of khat towards bezoar formation as a result of alteration in bowel motility. Case presentation: This is the case of a 60 years old farmer presented to our Hospital complaining Periumbilical abdominal pain of 3 days duration. He had the cardinal symptoms of obstruction. Historically he used to have intermittent episodes of constipation, otherwise no similar attack before. His staple diet was porridge made of wheat flour mixed with cooked and crushed potato along with cabbage consumed twice a day. He regularly chews Khat, a green leaf which has different chemicals known to have stimulant effect and cause decreased bowel motility. Discussion: There are diverse reasons behind bezoar formation that cause bowel obstruction; out of which a preoperative diagnosis is made for few. The attributing factors were known retrospectively for majority of the cases but others remain speculations with different scientific reasoning. In our case, almost the main risk factors incriminated in the causation of bezoar formation and bowel obstruction were assessed with no supportive evidence other than khat associated constipation which has normalized after chewing khat was stopped. Additionally, tannin, an extract of khat polymerizes in an acidic environment to form a glue-like coagulum which can affix to other materials in the stomach that predisposed to bezoar formation. Conclusion: In patients having features of small bowel obstruction, complaining chronic constipation and who has regular khat chewing habit has to be suspected to have a bezoar as a cause. Bowel motility improves upon stopping chewing khat which may help decrease the recurrence of bezoar formation.