Homthavong, Phonexay

Natarajan, Divya K

Trehan, Indi

English

Digital Commons@Becker

Washington University School of Medicine Digital Commons@Becker Open Access Publications 2019 Small bowel obstruction secondary to wild banana seed ingestion Divya K Natarajan Phonexay Homthavong Indi Trehan Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs Am. J. Trop. Med. Hyg., 101(6), 2019, pp. 1195–1196doi:10.4269/ajtmh.19-0586Copyright © 2019 by The American Society of Tropical Medicine and HygieneImages in Clinical Tropical MedicineSmall Bowel Obstruction Secondary to Wild Banana Seed IngestionDivya K. Natarajan,1 Phonexay Homthavong,2,3 and Indi Trehan1,2*1Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri; 2Lao Friends Hospital for Children, Luang Prabang, Lao PDR;3Luang Prabang Provincial Hospital, Luang Prabang, Lao PDRA previously healthy 13-year-old boy from a rural village innorthern Laos presented with progressive abdominal pain,constipation, emesis, and marked abdominal distention. Ra-diographs showed a small bowel obstruction which did not re-solve 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 ofbanana seeds (Figure 3). The patient tolerated surgery well andhad an unremarkable postoperative course.Further history obtained postoperatively revealed that beforepresentation, the patient was hungry and foraging for food for sev-eral days as his family was without means and reliable access tofood. He chanced on a wild banana tree and indulged in its fruits.The offending fruit, Musa balbisiana, is a wild bananaspecies native to Southeast Asia, spanning from India toPapua New Guinea (Figure 4). Ingestion of the fruit seeds isknown to cause intestinal complications, including con-stipation, appendicitis, and small bowel obstruction, mostcommonly in rural, impoverished populations because oflimited access to safe nutrition.1–4 Despite local wisdom toavoid these dangerous fruits and multiple reports of wildbanana ingestion–related bowel obstruction, cases like thisdemonstrate the impact that food insecurity and starvationcan have on impoverished populations.Received August 8, 2019. Accepted for publication August 16, 2019.Authors’ addresses: Divya K. Natarajan, Department of Pediatrics,Washington University in St. Louis, St. Louis, MO, E-mail: dknatara@wustl.edu. PhonexayHomthavong, LuangPrabangProvincial Hospital,FIGURE 1. Abdominal X-ray demonstrating small bowel obstruction.FIGURE 2. Intraoperative finding of bezoar causing bowel obstruc-tion. Individual banana seeds are visible through the intestinal lumen.This figure appears in color at www.ajtmh.org.FIGURE 3. Phytobezoar specimens extracted from the bowel. Thisfigure appears in color at www.ajtmh.org.* Address correspondence to Indi Trehan, Indi Trehan, One Children’sPlace, Campus Box 8116, St. Louis, MO 63110. E-mail: indi@alum.berkeley.edu1195LuangPrabang, LaoPDR,E-mail: phonexay23866868@gmail.com. IndiTrehan, 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.This isanopen-accessarticledistributedunder the termsof theCreativeCommons Attribution License, which permits unrestricted use, distri-bution, and reproduction in any medium, provided the original authorand source are credited.REFERENCES1. Chai FY, Heng SS, Asilah SM, Adila IN, Tan YE, Chong HC, 2016.Wild banana seed phytobezoar rectal impaction causing in-testinal obstruction. Indian J Surg 78: 326–328.2. Schoeffl V, Varatorn R, Blinnikov O, Vidamaly V, 2004. Intestinalobstruction due to phytobezoars of banana seeds: a case re-port. Asian J Surg 27: 348–351.3. Slesak G, Mounlaphome K, Inthalad S, Phoutsavath O, MayxayM,Newton PN, 2011. Bowel obstruction from wild bananas: aneglected 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 systematicreview of case reports and case series. Cureus 11: e4686.FIGURE 4. Wild banana plant Musa balbisiana native to SoutheastAsia depicting large seeds capable of causing intestinal obstructionthrough formation of phytobezoar. (Image courtesy of Scott Zona.)This figure appears in color at www.ajtmh.org.1196 NATARAJAN AND OTHERS

Small bowel obstruction secondary to wild banana seed ingestion

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Small bowel obstruction secondary to wild banana seed ingestion

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