BMJ Case Reports 2018; doi:10.1136/bcr-2017-223176
  • Rare disease

Giant granadilla’s seeds phytobezoar rectal impactation: a very unusual case of intestinal obstruction

  1. Pedro Raimundo
  1. Departamento de Medicina Interna e Medicina Intensiva, Hospital da Luz Lisboa, Lisboa, Portugal
  1. Correspondence to Dr Pedro Raimundo, p_oliveiraraimundo{at}
  • Accepted 30 January 2018
  • Published 8 February 2018


A 78-year-old Caucasian man presented to the emergency department with bloody diarrhoea, diffuse abdominal pain and fever with 1-week duration. He had just returned from Angola where he had been treated for a presumed Clostridium difficile infection without improvement. He had no relevant medical or familiar history except for hypertension and prostate benign hyperplasia. He was drowsy, feverish and eupnoeic. His oxygen saturation on pulse oximetry was 92%, blood pressure was 173/99 mm Hg and pulse rate 100 beats per minute. Except for a distended, silent and painful abdomen, particularly on lower quadrants, the rest of the examination was unremarkable. A CT showed a mesh-like mass inside the rectum conditioning colonic obstruction and distention. This turned to be a giant granadilla’s seeds phytobezoar and was removed endoscopically. Five days later, the patient had a colonic perforation requiring total colectomy. He made a full recovery after rehabilitation for 3 months.


  • Contributors ARA wrote the summary, background, case presentation, investigations, differential diagnosis, treatment, outcome and follow-up, discussion and learning points. LDC and PR reviewed the whole article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article