title: Prickly pear fruit bezoar presenting as rectal perforation in an elderly patient.
abstract: OBJECTIVE
  Prickly pear fruit rectal seed bezoars are an extremely rare entity. Only nine cases of rectal seed bezoar have been reported, only one of which involved the prickly pear fruit seed. Furthermore, to our knowledge, this is also the first reported case presenting as rectal perforation.
  
  
  METHODS
  We report a case of prickly pear fruit bezoar occurring in the elderly whom presented with rectal perforation. Consistent with physical signs, laboratory results, and radiological findings the patient was diagnosed with acute perforation of the rectum. A Hartman procedure was performed, and a colostomy was placed.
  
  
  RESULTS
  Currently there are very few data regarding seed bezoars reaching the rectum. There are even fewer data concerning this occurrence in the elderly, and the literature contains no report of this phenomenon presenting or even progressing into perforation. We report this rare entity to the existing literature.
  
  
  CONCLUSIONS
  We report a rare but important case. A prickly pear fruit phytobezoar presenting as rectal perforation. This case may add to the increasing awareness of the danger associated with ingestion of certain foodstuffs. The previously benign sunflower and psyllium seeds are now known to cause bezoar. We feel that the prickly pear fruit should join this small but important list.
authors.affiliation: Department of Surgery, Western Galilee Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. jatlantis7@aol.com
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Steinberg
authors.forename: Arieh
authors.initials: A
authors.lastname: Eitan
mesh_terms: D000368:Aged; D001630:Bezoars / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D005244:Fecal Impaction / Q000209:etiology*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000473:pathology; D029747:Opuntia; D012002:Rectal Diseases / Q000473:pathology*; D012639:Seeds / Q000009:adverse effects