• View in gallery
    Figure 1.

    Abdominal X-ray demonstrating small bowel obstruction.

  • View in gallery
    Figure 2.

    Intraoperative finding of bezoar causing bowel obstruction. Individual banana seeds are visible through the intestinal lumen.

  • View in gallery
    Figure 3.

    Phytobezoar specimens extracted from the bowel.

  • View in gallery
    Figure 4.

    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.)

  • 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: 326328.

    • Search Google Scholar
    • Export Citation
  • 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: 348351.

    • Search Google Scholar
    • Export Citation
  • 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: 8590.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
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Small Bowel Obstruction Secondary to Wild Banana Seed Ingestion

Divya K. NatarajanDepartment of Pediatrics, Washington University in St. Louis, St. Louis, Missouri;

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Phonexay HomthavongLao Friends Hospital for Children, Luang Prabang, Lao PDR;
Luang Prabang Provincial Hospital, Luang Prabang, Lao PDR

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Indi TrehanDepartment of Pediatrics, Washington University in St. Louis, St. Louis, Missouri;
Lao Friends Hospital for Children, Luang Prabang, Lao PDR;

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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.

Figure 1.
Figure 1.

Abdominal X-ray demonstrating small bowel obstruction.

Citation: The American Journal of Tropical Medicine and Hygiene 101, 6; 10.4269/ajtmh.19-0586

Figure 2.
Figure 2.

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

Figure 3.
Figure 3.

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.14 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.

Figure 4.
Figure 4.

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: 326328.

    • Search Google Scholar
    • Export Citation
  • 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: 348351.

    • Search Google Scholar
    • Export Citation
  • 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: 8590.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Indi Trehan, Indi Trehan, One Children’s Place, Campus Box 8116, St. Louis, MO 63110. E-mail: indi@alum.berkeley.edu

Authors’ addresses: Divya K. Natarajan, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, E-mail: dknatara@wustl.edu. Phonexay Homthavong, Luang Prabang Provincial Hospital, Luang Prabang, Lao PDR, E-mail: phonexay23866868@gmail.com. Indi Trehan, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO and Lao Friends Hospital for Children, Luang Prabang, Lao PDR, E-mail: indi@alum.berkeley.edu.

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