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Title: Phytobezoar van zonnebloempitten bij twee kinderen
Author(s): WOJCIECHOWSKI M, STEVENS G, AUDIËNS H, STEGER PH
Journal: Tijdschrift voor Geneeskunde
Volume: 58    Issue: 16   Date: 2002   
Pages: 1037-1039
DOI: 10.2143/TVG.58.16.5001400

Abstract :
Wij beschrijven twee kinderen met zonnebloempitbezoars. Dit soort bezoars is typisch laag in het colon of het rectum gelokaliseerd en presenteert zich gewoonlijk als ernstige obstipatie en anale pijn. Bij rectaal onderzoek kan een stekelig en zacht krakend gevoel ("colonic crunch sign") aanwezig zijn. De behandeling bestaat uit lavementen na anale anesthesie of manuele desimpactie.





Sunflower seed phytobezoar in two children
We report the cases of two boys, 4 and 7 years old, with constipation and anal pain. One of them had red blood loss per anum. His constipation did not respond to enema therapy.
Physical examination in both patients revealed a crunching and prickly mass in the rectum. Rectosigmoidoscopy was performed in the boy with blood loss and revealed a bezoar of sunflower seed shells and traumatic anorectal fissures. In this boy the bezoar was removed by endoscopic forceps. In the other boy the rectal mass was removed by manual disimpaction; it also contained sunflower seed shells.

Sunflower seed bezoars have a typical localization in the lower colon, probably because the undigested shells are embedded in the thicker lower colonic fecal mass, which acts as a kind of cement.
In addition to their risk of bezoar formation sunflower seeds can be aspirated in the lower airways.
Parents are usually unaware of these two dangers and should be informed.

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