A previously healthy 13-year-old boy from a rural village in northern Laos presented with progressive abdominal pain, constipation, emesis, and marked abdominal distention. Radiographs showed a small bowel obstruction which did not resolve with conservative management (Figure 1). At laparotomy, a bezoar was identified as the cause of his bowel obstruction (Figure 2). Resection of the mass identified a phytobezoar of banana seeds (Figure 3). The patient tolerated surgery well and had an unremarkable postoperative course.
Abdominal X-ray demonstrating small bowel obstruction.
Citation: The American Journal of Tropical Medicine and Hygiene 101, 6; 10.4269/ajtmh.19-0586
Intraoperative finding of bezoar causing bowel obstruction. Individual banana seeds are visible through the intestinal lumen.
Citation: The American Journal of Tropical Medicine and Hygiene 101, 6; 10.4269/ajtmh.19-0586
Phytobezoar specimens extracted from the bowel.
Citation: The American Journal of Tropical Medicine and Hygiene 101, 6; 10.4269/ajtmh.19-0586
Further history obtained postoperatively revealed that before presentation, the patient was hungry and foraging for food for several days as his family was without means and reliable access to food. He chanced on a wild banana tree and indulged in its fruits.
The offending fruit, Musa balbisiana, is a wild banana species native to Southeast Asia, spanning from India to Papua New Guinea (Figure 4). Ingestion of the fruit seeds is known to cause intestinal complications, including constipation, appendicitis, and small bowel obstruction, most commonly in rural, impoverished populations because of limited access to safe nutrition.1–4 Despite local wisdom to avoid these dangerous fruits and multiple reports of wild banana ingestion–related bowel obstruction, cases like this demonstrate the impact that food insecurity and starvation can have on impoverished populations.
Wild banana plant Musa balbisiana native to Southeast Asia depicting large seeds capable of causing intestinal obstruction through formation of phytobezoar. (Image courtesy of Scott Zona.)
Citation: The American Journal of Tropical Medicine and Hygiene 101, 6; 10.4269/ajtmh.19-0586
REFERENCES
- 1.↑
Chai FY, Heng SS, Asilah SM, Adila IN, Tan YE, Chong HC, 2016. Wild banana seed phytobezoar rectal impaction causing intestinal obstruction. Indian J Surg 78: 326–328.
- 2.
Schoeffl V, Varatorn R, Blinnikov O, Vidamaly V, 2004. Intestinal obstruction due to phytobezoars of banana seeds: a case report. Asian J Surg 27: 348–351.
- 3.
Slesak G, Mounlaphome K, Inthalad S, Phoutsavath O, Mayxay M, Newton PN, 2011. Bowel obstruction from wild bananas: a neglected health problem in Laos. Trop Doct 41: 85–90.
- 4.↑
Manatakis DK, Acheimastos V, Antonopoulou MI, Balalis D, Korkolis DP, 2019. Gastrointestinal seed bezoars: a systematic review of case reports and case series. Cureus 11: e4686.