Computed tomography (CT) imaging revealed a proctophytobezoar. On follow-up questioning, the patient recalled consuming approximately 10 ounces of cooked quinoa, a nutritious, gluten-free, high-protein seed, just prior to the onset of her constipation.
A bezoar is a mass of poorly digested material that forms within the gastrointestinal tract—usually in the stomach—and less commonly in the small or large intestine. Trichobezoars (hair), lactobezoars (milk curd), phytobezoars (plant fiber), medication bezoars, and lithobezoars (small stones, pebbles, or gravel) are named after their contents.
Fecal impaction due to phytobezoars primarily composed of seeds has been associated with prickly pears, watermelons, sunflowers, pumpkins, pomegranates, and sesame seeds. This patient’s experience adds quinoa seeds to this list.
Treatment begins with a pharmacologic approach. When that fails, it’s time to perform a manual fragmentation and extraction of the fecal mass. Once fragmentation and partial expulsion has been achieved, one can then try a lubricating mineral oil enema, bisacodyl suppository, or rectal lavage. If the impaction extends beyond the reach of the fingers, sigmoidoscopic visualization and lavage are indicated.
Since conservative and comprehensive management to improve this patient’s condition failed, she was taken to the operating room for a proctosigmoidoscopic disimpaction. The patient made an uneventful recovery and was discharged on hospital Day 3.
Adapted from: Pelletier JF, Higgins GL, Haydar SA. Photo Rounds: Obstipation unresponsive to usual therapeutic maneuvers. J Fam Pract. 2012;61:353-355.