Asian Journal of Case Reports in Surgery

Surgical Management of an Extensive Axillary Cystic Hygroma in a 4 Day Old Neonate: A Case Report

2026-06-02T09:29:56+00:00

Cystic hygroma is a benign developmental malformation of the lymphatic system resulting from a lack of communication between the lymphatic and venous systems. Most common site of occurrence of a cystic hygroma is the neck (about 75%) followed by the axilla (20%) and about 1% in the mediastinum, groin and retroperitoneum. Small, simple cystic hygromas can be managed conservatively, whereas massive, complex cystic hygromas most often need surgical intervention. Patient-specific multidisciplinary approach, involving obstetrician, radiologist, paediatrician, paediatric surgeon (where available) and plastic surgeon, is advised in cases where extensive cystic hygromas are diagnosed pre-natally. Here we have a case of a neonate born with an extensive cystic hygroma in the left axillary region extending medially onto the chest wall upto the 8th rib and laterally till elbow that was managed via careful planning and surgical excision, while safeguarding the underlying muscular and neurovascular structures, followed by reconstruction.

Mcswain Type V Appendiceal Intussusception as a Lead Point in Infantile Ileocolic Intussusception: A Rare Case Report

2026-05-28T12:03:08+00:00

Both appendicitis and intussusception can have similar presentations which can pose diagnostic and therapeutic challenges. Appendiceal intussusception is a rare condition, particularly in infants, and may serve as a pathological lead point for ileocolic intussusception. While most early intussusceptions can be managed by non-surgical reductions, these appendiceal intussusceptions stand out as exceptions. Of the available literature, the youngest cases reported has been in 4-year old child and above. We report a 5-month-old male presenting with abdominal pain, red currant jelly stools, and a palpable abdominal mass. Imaging suggested ileo-colic intussusception, and surgical exploration revealed a markedly elongated appendix (~10 cm) acting as the lead point. Appendectomy with vice versa reduction of intussusception was performed successfully. This case highlights the importance of considering rare lead points in atypical presentations of intussusception in infancy.

Single-Incision Gasless Laparoscopic Management of Non-Parasitic Splenic Cyst: A Case Report

2026-06-01T09:48:23+00:00

Background: Non-parasitic splenic cysts are rare benign lesions that pose diagnostic and therapeutic challenges because of their varied etiology and clinical presentation. Recent advances in minimally invasive surgery, particularly single-incision gasless laparoscopy, have provided safer and cosmetically superior alternatives for spleen-preserving management. Splenic cysts possess an epithelial lining and often result from parasitic infection, whereas secondary splenic cysts (pseudocysts) lack an epithelial lining and typically arise secondary to trauma, infarction, or infection.

Aims: To describe the successful application of single-incision gasless laparoscopic fenestration for the management of a large non-parasitic splenic cyst in a young female patient, and to review the operative technique and clinical outcomes of this spleen-preserving minimally invasive approach.

Presentation of Case: A 19-year-old female presented with a two-month history of left upper abdominal discomfort. Imaging revealed an 8 × 8 cm cystic lesion at the superior pole of the spleen. Hydatid serology was negative, confirming a non-parasitic splenic cyst. Spleen-preserving laparoscopic fenestration via a single infraumbilical incision using a gasless technique was performed. Approximately 500 ml of serous fluid was aspirated and the anterior cyst wall was excised using a Ligasure device. The postoperative course was uneventful and the patient was discharged on the third postoperative day. Histopathology confirmed a splenic pseudocyst. At one-year follow-up, the patient was asymptomatic with no recurrence.

Discussion: Non-parasitic splenic pseudocysts are uncommon benign lesions increasingly managed with minimally invasive, spleen-preserving techniques. Single-incision gasless laparoscopic fenestration combines the cosmetic advantages of reduced port surgery with the physiological benefits of avoiding pneumoperitoneum-related hemodynamic and respiratory disturbances. This approach is particularly suited to superficially located cysts.

Conclusion: Single-incision gasless laparoscopic fenestration is a safe, effective, and cosmetically favorable approach for appropriately selected patients with non-parasitic splenic cysts. Careful patient selection, precise surgical technique, and diligent postoperative surveillance are essential to achieving optimal outcomes. This case report highlights significance of cosmetic minimally invasive spleen preserving approach for management of splenic cysts in a young female.

Enterobius Vermicularis: A Rare Presentation as Acute Appendicitis

2026-06-01T12:23:36+00:00

Enterobius vermicularis (pinworm) is a common intestinal helminth infection worldwide, particularly in developing regions. Although typically associated with mild gastrointestinal symptoms, its role in acute appendicitis remains controversial, with reports suggesting it may mimic or contribute to appendiceal inflammation.

We report the case of an 18-year-old female who presented with persistent lower abdominal pain, nausea, and anorexia. Clinical findings raised suspicion of acute appendicitis; however, ultrasonography was unremarkable and did not reveal definitive features of appendiceal inflammation. Despite negative imaging results, persistent symptoms necessitated surgical intervention.

Diagnostic laparoscopy and appendectomy were performed. Intraoperatively, the appendix was found to be inflamed and dilated, and a live E. vermicularis worm was observed emerging from the appendiceal lumen following transection, confirming appendiceal enterobiasis. Histopathology showed nonspecific chronic inflammatory changes. The patient received postoperative anti-helminthic therapy with albendazole and had an uneventful recovery with complete symptom resolution.

This case highlights the diagnostic challenge of parasitic appendiceal disease, particularly when routine laboratory and imaging findings are inconclusive. It underscores the importance of considering helminthic infection in patients with atypical presentations of suspected appendicitis, especially in endemic and resource-limited settings.

Uncommon Isolated Unilocular Splenic Hydatid Cyst: A Case Report

2026-06-02T10:20:24+00:00

Background: Hydatid disease is a parasitic infection commonly affecting the liver and lungs, while isolated splenic involvement is rare. Unilocular splenic hydatid cysts are uncommon and often present with nonspecific clinical symptoms, making diagnosis challenging.

Aims: To report a rare case of isolated unilocular splenic hydatid disease and to demonstrate the safety, feasibility, and clinical outcomes of a minimally invasive, spleen-preserving laparoscopic approach, including operative technique and perioperative management.

Presentation of Case: A 29-year-old male presented with a one-year history of dull, intermittent left hypochondrial pain. Imaging revealed a 5 × 4 cm unilocular cystic lesion at the superior pole of the spleen with internal septations and daughter cysts, classified as Gharbi Type II (WHO CE3b). Despite negative IgG serology, imaging characteristics were strongly suggestive of splenic hydatid disease. Following five days of preoperative albendazole therapy, laparoscopic spleen-preserving partial peri-cystectomy was performed using hypertonic saline as a scolicidal agent. Blood loss was minimal, and the postoperative course was uneventful. Histopathology confirmed an acellular laminated membrane with brood capsules and hydatid sand. At 12-month follow-up, the patient was asymptomatic with no evidence of recurrence.

Discussion: Isolated splenic hydatid disease accounts for less than 2% of all hydatid cases. Diagnosis relies on a combination of imaging and serology, though serological tests may be negative in up to 40% of splenic cases. Laparoscopic partial peri-cystectomy, combined with perioperative albendazole and meticulous intraoperative technique to prevent spillage, offers outcomes comparable to open surgery while preserving splenic immunological function.

Conclusion: Splenic hydatid disease warrants a high index of clinical suspicion, particularly in endemic regions. Laparoscopic management represents a safe and effective minimally invasive option, offering the dual advantages of spleen preservation and reduced postoperative morbidity when performed with meticulous technique and appropriate perioperative medical therapy.

Gastric Necrosis: An Unexpected Complication of Transarterial Embolization in a Critically Ill Poly Trauma Patient

2026-06-04T09:39:18+00:00

Transarterial embolization (TAE) is an effective minimally invasive procedure used for the management of gastrointestinal bleeding in hemodynamically unstable patients. Although the procedure has a high technical success rate, ischemic complications such as gastric necrosis are extremely uncommon because of the rich vascular supply of the stomach. We report a rare case of gastric necrosis following TAE for a pseudoaneurysm of the right gastroepiploic artery in a 22-year-old polytrauma patient. The patient sustained multiple traumatic injuries following a fall from a train and subsequently developed hemorrhagic shock, disseminated intravascular coagulation (DIC), septic shock, and multiorgan dysfunction requiring extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Despite successful embolization with coils, the patient developed progressive gastric ischemia and necrosis requiring emergency total gastrectomy with Roux-en-Y esophagojejunostomy. The patient gradually recovered and was discharged on follow-up. This case highlights the importance of considering ischemic complications after TAE in critically ill trauma patients with severe coagulopathy, vasopressor dependence, and prolonged hypoperfusion. Early recognition and timely surgical intervention are essential for improving patient outcomes.

Recurrent Refractory Iliopsoas Abscess Requiring Definitive Open Surgical Drainage with Adjunctive Marsupialization: A Case Report

2026-06-06T12:20:16+00:00

Background: Iliopsoas abscess (IPA) is an uncommon yet potentially life-threatening retroperitoneal suppurative infection associated with significant morbidity and mortality, particularly among immunocompromised individuals. Clinical manifestations are frequently nonspecific, often resulting in delayed diagnosis and progression to systemic sepsis. Although broad-spectrum antimicrobial therapy combined with image-guided percutaneous drainage remains the cornerstone of treatment, recurrent or refractory disease may necessitate definitive surgical intervention.

Case Presentation: We report the case of a 59-year-old female with poorly controlled diabetes mellitus and neurogenic bladder who presented with persistent pyrexia, right lumbar pain, and urinary tract infection. Initial radiological assessment demonstrated bilateral pyelitis, for which prolonged antimicrobial therapy was instituted. Despite extended intravenous antibiotic treatment and multiple image-guided percutaneous drainage procedures, the patient subsequently developed a persistent multiloculated left iliopsoas abscess with repeated recurrence. Serial computed tomography (CT) imaging demonstrated incomplete radiological resolution and progressive extension into the iliacus musculature. Owing to failure of conservative and minimally invasive management, the patient ultimately underwent definitive open surgical drainage with adjunctive marsupialization for durable source control and facilitation of postoperative cavity management.

Discussion: This case underscores the therapeutic challenges posed by recurrent iliopsoas abscesses in immunocompromised hosts. Although percutaneous drainage is generally associated with high success rates, refractory disease may persist in the presence of multiloculated collections, chronic inflammatory cavities, or impaired host immunity. Open surgical drainage provides direct access for complete evacuation of purulent material and disruption of loculations. Adjunctive marsupialization, a technique more traditionally employed in the management of Bartholin gland pathology, may provide additional benefit through sustained drainage, enhanced postoperative wound surveillance, and reduction of recurrent cavity formation.

Conclusion: Failure of prolonged antimicrobial therapy and repeated percutaneous drainage in iliopsoas abscess should prompt early consideration of definitive operative management. Adjunctive marsupialization may represent a valuable yet underreported surgical adjunct in the management of complex recurrent iliopsoas abscesses.

Incidental Solid Pseudopapillary Neoplasm of the Pancreas in a Young Female: Case Report and Literature Review

2026-06-08T07:14:01+00:00

Introduction: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare epithelial tumor with low malignant potential, predominantly affecting young women, and is often discovered incidentally.

Presentation of Case: We report the case of a 21-year-old female with no significant medical history who presented with one-month secondary amenorrhea. An abdominal ultrasound revealed an incidental pancreatic mass. Contrast-enhanced computed tomography and magnetic resonance imaging demonstrated a well-circumscribed lesion in the pancreatic body, without vascular invasion or metastatic spread. Endoscopic ultrasound-guided biopsy revealed solid and pseudopapillary architecture, and immunohistochemistry confirmed SPN. After multidisciplinary discussion, the patient underwent central pancreatectomy. Histopathological examination confirmed SPN staged pT2 Nx. The postoperative course was uneventful.

Conclusion: SPN should be considered in the differential diagnosis of pancreatic lesions in young women, even when incidentally discovered. In general, complete surgical resection, including parenchyma-sparing procedures such as central pancreatectomy, is associated with excellent long-term outcomes and prognosis in the vast majority of cases.

Laparoscopic Deroofing with Omentoplasty for Splenic Epidermoid Cyst: A Case Report

2026-06-09T12:46:09+00:00

Background: Splenic cysts are benign lesions which can be revealed by pain or a palpable mass, or present as complications: cyst rupture, intracystic haemorrhage or cyst infection.

Aim: The study aims to report a rare case of a large splenic epidermoid cyst successfully managed by laparoscopic deroofing combined with omentoplasty, highlighting a safe, organ-preserving surgical approach.

Presentation of Case: A 31-year-old female presented with a two-month history of intermittent dull aching pain in the left upper quadrant. Contrast-enhanced CT revealed a large (12.5 × 7 × 8 cm) septated cystic lesion at the upper pole of the spleen. Hydatid serology was negative. She underwent laparoscopic deroofing with omentoplasty without complications and was discharged on postoperative day five. Histopathology confirmed a splenic epidermoid cyst lined by stratified squamous epithelium.

Discussion: Splenic epidermoid cysts are rare congenital benign lesions with a predilection for young women. Laparoscopic deroofing with omentoplasty is a technically feasible, spleen-preserving strategy associated with low morbidity, rapid recovery, and low recurrence rates.

Conclusion: Laparoscopic deroofing with omentoplasty is a safe, effective, minimally invasive treatment for large symptomatic splenic epidermoid cysts. Post-operative surveillance imaging is recommended to detect any recurrence.

Surgical Management of a Giant Retroperitoneal Liposarcoma Presenting with Progressive Abdominal Distension: A Case Report

2026-06-09T12:54:20+00:00

Background: Retroperitoneal liposarcoma is a rare malignant soft-tissue tumour of mesenchymal origin that often remains clinically silent until it attains a considerable size. Owing to its deep anatomical location and nonspecific presentation, diagnosis is frequently delayed, making surgical management challenging.

Case Presentation: A 50-year-old man with a history of hiatal hernia surgery presented with progressive abdominal distension over six months, associated with compressive symptoms and a weight loss of 7 kg. Physical examination revealed a massive abdominal mass. Ultrasonography demonstrated a large heterogeneous retroperitoneal lesion compressing adjacent abdominal organs. Contrast-enhanced computed tomography identified a giant retroperitoneal fatty mass measuring 36 × 20 × 27 cm, displacing neighbouring viscera without evidence of distant disease. Laboratory investigations, including tumour markers, were within normal limits. Owing to concerns regarding tumour dissemination, preoperative biopsy was not performed. The patient underwent complete en bloc surgical excision of the tumour through a midline laparotomy. Histopathological examination confirmed the diagnosis of sclerosing liposarcoma. The postoperative course was uneventful, and the patient was placed on regular radiological surveillance.

Conclusion: Giant retroperitoneal liposarcomas are uncommon tumours that may reach enormous dimensions before diagnosis. Cross-sectional imaging plays a pivotal role in preoperative assessment, whereas complete surgical resection remains the cornerstone of treatment and offers the best chance for local disease control. Long-term follow-up is essential because of the high risk of local recurrence.

Transoral Migration of a Ventriculoperitoneal Shunt (VPS) Catheter in a Six-Month-Old Boy: A Case Report

2026-06-12T09:33:05+00:00

Introduction: Ventriculoperitoneal Shunt (VPS) is the gold standard for the treatment of hydrocephalus. Gastrointestinal perforation is rare, and perforation above the angle of Treitz is exceptional. We report a rare case of a VPS catheter externalized through the mouth in a six-month-old boy.

Case Presentation: This was a six-month-old patient with a history of spina bifida, for which he underwent surgery on his sixth day of life, followed by a ventriculoperitoneal shunt (VPS) for malformation-related tri-ventricular hydrocephalus on his tenth day of life. The reason for consultation was the protrusion of the VPS catheter through the mouth. The patient was admitted to the operating room for an exploratory procedure, and the end of the catheter protruding from the oral cavity was cut off under sterile conditions. The surgical exploration revealed multiple adherences between the loops. During adhesiolysis, the catheter was accidentally dislodged and ended up in the abdomen. We tried to locate the perforation but were unsuccessful. Conservative treatment was administered. The postoperative course was uneventful, and the patient was discharged on the eighth day.

Conclusion: Exteriorization of the VPS through the mouth is an extremely rare complication. Management requires emergency surgery, involving both a gastrointestinal exploration and verification of the VPS.

A Rare Case of Xanthogranulomatous Cholecystitis: Diagnostic Challenges and Surgical Management

2026-06-12T09:47:26+00:00

Background: Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder characterised by destructive inflammation and xanthogranulomatous infiltration. Its clinical, radiological, and intraoperative resemblance to gallbladder carcinoma often creates significant diagnostic and surgical challenges.

Case Presentation: A 63-year-old man with no significant medical history presented with a four-month history of right upper quadrant pain radiating to the right shoulder. Physical examination revealed right upper quadrant tenderness and a positive Murphy’s sign. Ultrasonography demonstrated a multilithiasic gallbladder with thin walls, while laboratory investigations were within normal limits. Laparoscopic exploration revealed a markedly thickened gallbladder with inflammatory changes suggestive of a more aggressive pathology. Cholecystectomy was successfully performed without complications. Histopathological examination confirmed xanthogranulomatous cholecystitis and excluded malignancy.

Discussion: XGC predominantly affects older adults and is frequently associated with gallstones. Despite advances in imaging, distinguishing XGC from gallbladder carcinoma remains difficult due to overlapping clinical and radiological features. Intraoperative findings may appear suspicious for malignancy, potentially leading to extensive surgical procedures. Histopathological evaluation remains the gold standard for definitive diagnosis, while complete cholecystectomy is generally curative and associated with favourable outcomes.

Conclusion: This case highlights the diagnostic complexity of XGC and the crucial role of histopathological examination in establishing an accurate diagnosis. Awareness of this uncommon entity is essential to avoid unnecessary radical surgery and to ensure appropriate surgical management.

Neglected Tibial Fracture with Severe “Saber-Shin” Deformity Revealing Osteogenesis Imperfecta in a 12-Year-Old Girl: A Case Report

2026-06-13T11:30:38+00:00

Background: Osteogenesis imperfecta (OI), also known as brittle bone disease, is a rare genetic multisystem disorder of Type I collagen associated with bone fragility, fractures and connective tissue abnormalities, with highly heterogeneous phenotypic features and varying genetic basis. Delayed or neglected fractures in affected individuals may lead to severe deformities and functional impairment.

Case Presentation: We report the case of a 12-year-old female admitted for a significant deformity of the right leg following a neglected tibial diaphyseal fracture sustained eight months prior. Clinical examination revealed short stature and characteristic blue sclerae, suggesting an underlying connective tissue disorder. Radiographic evaluation demonstrated a malunited tibial shaft fracture with severe anterior bowing, producing a characteristic “saber shin” deformity. Management required a multidisciplinary approach, including corrective osteotomies with intramedullary nailing and the initiation of bisphosphonate therapy and rehabilitation.

Discussion: In the present case, delayed orthopaedic management resulted in a malunited tibial fracture with severe anterior bowing, producing the characteristic “saber shin” deformity. The coexistence of this deformity with systemic features such as blue sclerae and short stature strongly suggested an underlying connective tissue disorder, leading to further investigation and confirmation of osteogenesis imperfecta. This case highlights the importance of early recognition of osteogenesis imperfecta in children presenting with atypical fractures or progressive deformities, as prompt diagnosis and appropriate management are essential to prevent severe skeletal complications and improve functional outcomes.

Conclusion: Neglected fractures in children with undiagnosed osteogenesis imperfecta may lead to severe progressive deformities. Early recognition of systemic signs and appropriate orthopaedic management are essential to prevent disabling skeletal complications.

Synchronous Pancreatic Head Well-Differentiated Neuroendocrine Tumor and Left Adrenal Composite Pheochromocytoma: A Rare Case with Successful Pancreaticoduodenectomy and Left Adrenalectomy

2026-06-15T09:12:32+00:00

Background: Synchronous pancreatic neuroendocrine neoplasms and adrenal tumors represent rare diagnostic and therapeutic challenges.

Case Presentation: This study reports a 39-year-old woman presenting with vague abdominal pain and recurrent vomiting. Imaging (USG, CECT, MRCP) revealed a cystic solid lesion in the pancreatic head and a separate left adrenal mass. Tumor markers (CEA, CA 19-9) were normal. The patient underwent pancreaticoduodenectomy and left adrenalectomy with an uneventful postoperative course. Final histopathology confirmed a well-differentiated Grade 1 neuroendocrine tumor of the pancreatic head and a composite pheochromocytoma of the left adrenal gland. At 3-month follow-up, the patient remained asymptomatic and continued surveillance and endocrine evaluation. ¹⁸F-FDG PET/CECT demonstrated only mild postoperative inflammatory uptake in the surgical beds, with no evidence of residual, recurrent, or metastatic disease, supporting complete oncological resection and favorable early outcome.

Conclusion: This case highlights the importance of multimodal imaging and surgical management in synchronous tumors and suggests consideration of genetic evaluation.

Hepatic and Retrovesical Hydatid Disease: A Rare Case of Multivisceral Hydatidosis

2026-06-15T09:20:04+00:00

Hydatidosis is endemic in Morocco. Although hepatic involvement is common, pelvic and retrovesical localizations are exceptionally rare. This study reports the observation of a patient aged 60 years who has presented for one year with paroxysmal pain in the right hypochondrium and a sensation of heaviness, as well as a notion of pollakiuria. Clinical examination revealed a firm, painless, and well-defined abdominal mass extending from the right hypochondrium to the epigastric region. Abdominal and pelvic CT revealed multiple hydatid cysts in the left liver and a retrovesical cystic mass. The diagnosis of hydatid cyst of the bladder was made intraoperatively. The surgical procedure involved resecting the protruding dome, aspirating the hydatid fluid, removing the daughter vesicles, and thoroughly washing the endocyst. Early recognition and appropriate surgical and medical management are essential to prevent complications and recurrence. Strengthening primary prevention measures, particularly canine control and food hygiene, remains fundamental to reducing the burden of hydatid disease in endemic countries.

Massive Pneumoperitoneum from Barogenic Gastric Injury Complicating Difficult Mask Ventilation: A Case Report

2026-06-15T10:15:09+00:00

Background: Gastric insufflation during airway management is common, but progression to gastric wall injury with pneumoperitoneum is rare. This report describes a case of massive pneumoperitoneum caused by barogenic gastric injury after difficult mask ventilation during an elective procedure performed under sedation.

Case Presentation: A 55-year-old woman with a history of three previous abdominopelvic operations for uterine leiomyoma underwent direct laryngoscopy under sedation for a left vocal-fold polyp. The procedure was complicated by oxygen desaturation, requiring prolonged bag-mask ventilation and several intubation attempts before the airway was secured. Marked abdominal distension developed and did not resolve after nasogastric aspiration. Thoraco-abdomino-pelvic computed tomography demonstrated a large-volume pneumoperitoneum, and the patient was transferred for emergency surgical management. On arrival, she was haemodynamically stable, with diffuse abdominal distension and tympany. Diagnostic laparoscopy confirmed pneumoperitoneum and revealed three serosal lacerations of the stomach, each approximately 3 cm long. There was no peritoneal effusion, and the colon and small bowel were intact. A methylene-blue leak test was negative, indicating no demonstrable full-thickness gastric leak at the time of surgery. The gastric lacerations were repaired with simple interrupted 2-0 polyglactin sutures. The postoperative course was uneventful, bowel transit resumed by the third postoperative day, and the patient was discharged in good condition on the fourth postoperative day.

Conclusion: Acute abdominal distension after difficult mask ventilation or repeated intubation attempts should prompt suspicion of barogenic gastric injury. Even when intraoperative leak testing is negative, partial-thickness gastric tears may be clinically significant and warrant careful inspection and repair.

Subocclusive Syndrome Revealing a Lithophagia-Type PICA in a 5-Year-Old Child: A Case Report

2026-06-17T09:00:42+00:00

Background: Pica is defined by the persistent ingestion of non-nutritive substances and may lead to gastrointestinal and haematological complications. Lithophagia, the ingestion of stones, is an uncommon form of pica and is rarely reported as a cause of subocclusive syndrome in children. This case report describes a five-year-old child with lithophagia complicated by colonic accumulation of stones, subocclusive symptoms and severe anaemia.

Case Presentation: A five-year-old female child from the Fez-Meknes region of Morocco presented with a three-day history of failure to pass stools, abdominal pain during attempts at defecation and a two-year history of pica with passage of stones in the stool. She had no previous hospitalisation and no reported family history of behavioural or psychiatric disorders. On examination, she was conscious and clinically stable, with pale conjunctivae and mild abdominal distension. The abdomen was soft but firm in some areas and painful on deep palpation. A plain abdominal X-ray showed multiple calcified opacities throughout the colonic region. Laboratory investigations revealed microcytic anaemia with a haemoglobin level of 5.6 g/dL, thrombocytopenia of 33,000 cells/mm³, a white blood cell count of 21,000 cells/mm³ and a C-reactive protein level of 43 mg/L. The diagnosis was subocclusive syndrome in the context of lithophagia-type pica complicated by severe anaemia. Management included dietary measures, rehydration, analgesia, antibiotic therapy, red blood cell transfusion, oral laxatives and repeated manual rectal evacuation under sedation. After three evacuation procedures, the colon was radiologically cleared and bowel movements resumed normally. The patient was discharged after ten days and referred for child psychiatric follow-up.

Conclusion: Lithophagia should be considered in children presenting with constipation, abdominal symptoms and unusual eating behaviour. Early diagnosis and multidisciplinary management may allow successful conservative treatment and avoid surgical intervention.