Sponge bezoar: a rare cause of abdominal pain.

A 21/2 year old boy presented with a 24-hour history of an acute abdomen. At appendicectomy, a number ofpolyurethane pieces were found to be occluding the terminal ileum. The polyurethane foam, the stuffing of a sofa, had been swallowed repeatedly. Ingestion of such a substance is not without risk. Unlike inhaled foreign bodies, ingested foreign bodies rarely cause clinical problems. This case illustrates that repeated ingestion of a common substance, polyurethane sponge, can cause intestinal obstruction in the young. CASE REPORT A 2 1/2 year old boy presented to the accident and emergency department of the Royal Belfast Hospital for Sick Children with a four-month history of vague lower abdominal pain and pain on defecation. In the 24 hours prior to presentation his pain had increased and was localised in the right flank. It was associated with non-bilious vomiting. His bowels had opened the previous evening. On examination his temperature was 37.6°C. His abdomen was minimally distended and was tender with guarding in the right flank. Bowel sounds were normal. Rectal examination was unremarkable. The patient's white cell count was elevated at 15.8 x 109/L.3 A plain supine film of abdomen showed only a few dilated loops of ileum, but there was air throughout the bowel (Fig.). A presumptive diagnosis of acute appendicitis was made. A Lanz incision was made. The small bowel was noted to be distended and the distal ileum contained several hard foreign bodies, one of which had occluded the terminal ileum 10 cm from the ileo-caecal valve. It could not be milked forward. The material was removed through a longitudinal enterotomy, which was closed transversely. The appendix was removed. On inspection, the foreign bodies were found to consist ofpolyurethane foam. The largest particle was 2 cm x 3 cm. Histopathology showed a fibrillary eosinophilic material in which vegetable material was embedded. Many bacterial organisms were identified. Recovery was uneventful and he was discharged six days later. Figure Plain abdominal X-ray showing a few dilated loops of bowel, but with air clearly visible in the rectum.