Rectal seed bezoar causing fecal impaction following Schleichera oleosa (Kusum) ingestion in a child: A rare primary care encounter

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BSTRACT

Seed bezoars are an uncommon cause of fecal impaction in children and may progress to intestinal obstruction. Schleichera oleosa (Kusum, Ceylon oak, or lac tree) bears a seasonally consumed acidic fruit in many parts of India, but gastrointestinal complications from ingestion of its seeds have not, to our knowledge, been previously reported. We describe an 8-year-old boy who presented with 1 week of constipation, abdominal pain, vomiting, abdominal distension, and overflow fecal leakage. Digital rectal examination revealed multiple hard, smooth seeds densely impacted within the rectum. Bedside manual evacuation removed numerous seeds with immediate symptomatic relief, and a focused dietary history confirmed ingestion of a large quantity of S. oleosa fruit several days earlier. Recognition at the primary care level through careful history-taking and rectal examination established the diagnosis without advanced imaging and averted progression to complete obstruction and possible surgery. This case adds a previously unreported fruit to the list of seed bezoars and underscores the diagnostic value of a dietary history and digital rectal examination in pediatric fecal impaction, particularly in regions where seasonal fruit consumption is common.