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From question on page 1122

Abdominal x ray film showed an opaque 8 cm mass in the pelvis outlined by gas. The diagnosis of rectosigmoid bezoar was made. Subsequently performed barium enema confirmed the diagnosis showing an intraluminal filling defect with no attachment to the wall.

Enemas with warm saline resulted in passage of the bezoar; transanal evacuation was aided manually. Colonoscopic follow up detected no bezoar formation or other pathology.

Nearly 60% of colonic bezoars present with abdominal pain, sometimes associated with a palpable mass, abdominal distension, vomiting, constipation, or diarrhoea. The diagnosis of colonic bezoar is typically made with plain abdominal radiograph and barium enema. The method of bezoar removal depends on the site of impaction, and size, nature, and complications of the formation. Conservative management includes enemas and manual disimpaction. Colonoscopic removal is considered if enemas fail. Surgery is reserved for bezoars defeating conservative management, and for those presenting with life threatening complications such as sigmoid volvulus, haematochezia, ileus, or peritonitis.

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