Asian Journal of Case Reports in Surgery

Seeded Trouble: A Case Report of Sigmoid Colon Perforation Due to Rambutan Seed

Chieng Loo Ling *

Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Anil Kumar A/L Sree Kumar Pillai

Department of General Surgery, Sibu General Hospital, Sarawak, Malaysia.

Prasad Mothayapan

Department of General Surgery, Sibu General Hospital, Sarawak, Malaysia.

Tiong How Chieng

Department of General Surgery, Sibu General Hospital, Sarawak, Malaysia.

*Author to whom correspondence should be addressed.

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Abstract

Introduction: Rambutan (Nephelium lappaceum), a tropical fruit indigenous to Southeast Asia, is popularly consumed for its sweet-sour pulp, however, it poses a significant risk when its seeds are ingested, especially in the elderly population as there is a probability of developing gastrointestinal obstruction or perforation. Perforation of the gastrointestinal tract attributed to foreign body ingestion is rare and it poses a significant challenge in emergency surgical care.

Case Report: We present a case of sigmoid colon perforation by rambutan seeds in a 71-year-old gentleman. Imaging investigations revealed the presence of foreign bodies with evidence of colonic perforation. Subsequently, a Hartmann's Procedure was performed and the patient was discharged after 9 days of hospital stay.

Discussion: Gastrointestinal perforation by foreign body ingestion is rare and typically involves sharp items such as toothpicks, needles, poultry or fish bones, and fruit seeds. Symptoms vary but often include severe abdominal pain, nausea, and vomiting often necessitating careful clinical evaluation. Imaging modalities such as CT scans aid in identifying the site of perforation hence playing an important role in guiding treatment decisions. Treatment approaches are often than not tailored to each patient and these options may include abscess drainage, antibiotic therapy, or surgical interventions such as bowel resection.

Conclusion: This case highlights the rare possibility of bowel perforation in the absence of obstructive symptoms, due to the ingestion of multiple non-sharp seeds. It also emphasizes the importance of prompt surgical intervention to achieve a favorable clinical outcome.

Keywords: Rambutan, sigmoid colon, perforation, complication, surgical intervention

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