Uncommon Presentation of Intestinal Lithobezoar in an Elderly Female: A Case Report

Abstract

Intestinal litho-bezoars, comprising accumulations of ingested foreign bodies, are rare clinical entities often associated with unusual dietary habits. We present a case of a 73-year-old female who presented with abdominal distension and pain. Clinical examination revealed tachycardia, hypertension, low oxygen saturation, and tachypnea. An abdominal X-ray and non-contrast computed tomography revealed gaseous distension with a radio-opaque mass in the right iliac fossa. The patient underwent an emergency exploratory laparotomy, which revealed a hard, immovable mass located 40 cm proximal to the ileocecal junction. Enterotomy was performed, and a 5x4 cm single, ovoid, brown-colored, hard lithobezoar weighing 47 grams was extracted. The proximal bowel loop exhibited dilation and ischemic changes, necessitating a 15 cm ileal resection with a two-layer ileal anastomosis. Stone analysis confirmed the composition as calcium oxalate, with histologically identifiable vegetative material on the outer surface. Detailed dietary history revealed a lifelong habit of consuming mud. This case highlights the importance of considering rare etiologies in patients presenting with acute abdominal symptoms, especially in elderly individuals. Intestinal lithobezoars, though uncommon, should be considered in the differential diagnosis, particularly when associated with distinctive dietary habits. Timely recognition and intervention are crucial to prevent life-threatening complications and ensure optimal patient outcomes.