Eating styrofoam balls presented as intestinal obstruction- PICA associated with bezoar: a rare case report and review of literature


  • Altaf G. Haji Department of Surgery, George Elliot NHS Hospital, England
  • Naveen Sivakumar Department of Surgery, George Elliot NHS Hospital, England
  • Bala Piramanayagam Department of Surgery, George Elliot NHS Hospital, England
  • A. Palit Department of Radiology, George Elliot NHS Hospital, England



Styrofoam, Bezoar, Obstruction


Gastrointestinal obstruction secondary to foreign body bezoars (industrial materials, plastic, tissue paper, sponge) have been reported but foreign body bezoar with styrofoam has never been reported in literature. PICA associated bezoars are an unusual complication and reports say that a wide variety of substances are consumed, ranging from socks, newspapers, and sofa pillows to dirt and hair and in this case, it was ingestion of styrofoam balls. Styrofoam being foam plastic does not breakdown or get absorbed in body when ingested, but its persistent ingestion creates bezoar which can fill the whole gastrointestinal tract.

Author Biography

Altaf G. Haji, Department of Surgery, George Elliot NHS Hospital, England

Consultant GI and General Surgery

Department of Surgery

George Elliot NHS Hospital,UK



Iwamuro M, Okada H, Matsueda K, Inaba T, Kusumoto C, Imagawa A, et al. Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc. 2015;7(4):336-45.

Yau KK, Siu WT, Law BK, Cheung HY, Ha JP, Li MK. Laparoscopic approach compared with conventional open approach for bezoar-induced small-bowel obstruction. Arch Surg. 2005;140(10):972-5.

Saima QM, Bhanger MI., Hasany SM, Khuhawar MY. Sorption behavior of impregnated styrofoam for the removal of Cd(II) ions. Colloid Surf A. 2006;279(1-3):142-8.

Usman S, Razis AFA, Shaari K, Azmai MNA, Saad MZ, Isa NM. Polystyrene microplastics induce gut microbiome and metabolome changes in Javanese medaka fish (Oryzias javanicus Bleeker, 1854). Toxicol Rep. 2022;9:1369-79.

Park SE, Ahn JY, Jung HY, Na S, Park SJ, Lim H, et al. Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver. 2014;8(4):400-7.

Tay YK, Levy ML, Metry DW. Trichotillomania in childhood: case series and review. Pediatrics. 2004;113(5):e494-8.

Dhakal OP, Dhakal M, Bhandari D. Phytobezoar leading to gastric outlet obstruction in a patient with diabetes. BMJ Case Rep. 2014;2014:bcr2013200661.

Pujar KA, Pai AS, Hiremath VB. Phytobezoar: a rare cause of small bowel obstruction. J Clin Diagn Res. 2013;7(10):2298-9.

Gayer G, Jonas T, Apter S, Zissin R, Katz M, Katz R, et al. Bezoars in the stomach and small bowel--CT appearance. Clin Radiol. 1999;54(4):228-32.

Chen YC, Liu CH, Hsu HH, Yu CY, Wang HH, Fan HL, et al. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction. Eur Radiol. 2015;25(4):922-31.

Kuang LQ, Zhao DW, Cheng C, Wang Y. Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings. Biomed Res Int. 2016;2016:6569103.

Ted XG, Richard E, Jared R. S2257 Colonoscopic Decompression of a Bezoar-Induced Small Bowel Obstruction. American J Gastroenterol. 2021;116:S963.

Ladas SD, Kamberoglou D, Karamanolis G, Vlachogiannakos J, Zouboulis-Vafiadis I. Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment. Aliment Pharmacol Ther. 2013;37(2):169-73.






Case Reports