Colonic obstruction secondary to lithobezoar in a child

A nine-years-old girl with no history of abdominal surgery was presented to the emergency department with a seven-days-lasting abdominal pain, yellow vomiting and constipation; the stool was brownish mixed with small stones. There was no history of fever or similar episodes. Her development history revealed multiple episodes of earth and stone-eating since her 3 years. The physical examination revealed a well-developed child with stable vital signs, the abdomen was slightly distended and tense in its lower part. There was a palpable lump in the hypogastric area and in left iliac fossa. Rectal examination demonstrated a rectal ampulla full of small stones. Abdominal X-ray showed gravel inside the large bowel and rectum with a distended transverse and left colic angle. Manual evacuation, and colonic lavage were done and repeated twice daily for three days. At the fourth day an abdominal X-ray showed clearance of all stones from the colon and no signs of colonic obstruction or perforation.