Low colonic obstruction due to Opuntia ficus indica seeds: the aftermath of enjoying delicious cactus fruits Sir

Sir, Faecal impaction is a well-known medical problem. Habitual constipation of childhood and chronic constipation of the elderly are frequently the reasons for this condition (1, 2). Faecal impaction with cactus prickly pear seeds has not received sufŽ cient attention. In 1976, Bartha reported a single case in an elderly woman (3). In our paper we present faecal impaction with cactus seeds as a well-deŽ ned entity. We studied the medical reports of children admitted to our department with a diagnosis of faecal impaction during the past 10 y. We found that in the latter part of every summer, an average of 2–3 children were admitted with painful faecal impaction after eating prickly pears (Opuntia Ž cus indica). This cactus plant is common in Israel and in summer time the fruits are ripe. As a rule, these children were of Bedouin origin and aged between 5 and 9 y, and they came to the paediatric ER one or two days after eating large amounts of the cactus fruits. Painful faecal impaction, low abdominal pain, difŽ culties in walking and occasional rectal bleeding were the cardinal complaints. A foul odour usually emanated from the child. Abdominal examination revealed left lower quadrant tenderness and the outline of a tender left colonic loop. Rectal examination was extremely painful and demonstrated dense granular masses and was often impossible to perform. Treatment consisted of evacuation of the masses under general anaesthesia, a procedure that is quite traumatic and often associated with rectal bleeding. Some children needed a second procedure because of very large amounts of seeds continuing to reach the rectum from above and non-evacuated during the Ž rst procedure. Recovery after evacuation of impaction was uneventful. Cactuses originate in North and South America and the West Indies. After the discovery of America, cactuses were introduced to most countries around the world. There are more than 1500 species in the cactus family. Opuntia Ž cus indica is a widely cultivated species and grows well around the Mediterranean basin, in Mexico, Australia and South Africa,  owering in the spring. The next 80–90 d are a period of fruit growth and ripening (4, 5). The cactus pear is a medium-sized (100–200 g), oblong, greenish fruit consisting of a Ž rm peel and a soft pulp (Fig. 1). The peel is covered with small spines (glochids). The pulp contains from 50 to 300 seeds, 1– 2 mm in size. The pulp is variously green, yellow and red in colour (4, 5) and is usually eaten along with the tiny seeds. Opuntia Ž cus indica can be used for many practical purposes. The plant serves as animal food as well as in salads and cooked dishes with meat. Insects using cactuses as a host plant produce different dyes. Fruit juices, concentrate, jams, jellies, alcoholic drinks and sweet cheese are made from this fruit, mainly in Mexico. Glucose control in diabetes mellitus, reduction of triglycerids and cholesterol levels and improvement in prostatic function are well-known pharmacological properties of its stem and  owers (4, 5). The pears of Opuntia Ž cus indica are delicious and are served cold as a dessert (after removing the prickly peel). As already stated, large amounts of Opuntia Ž cus indica grow in our region, some of them in the wild. In the latter part of summer the fruit appears in the markets and everyone may be exposed to the above-mentioned problem. Plants are found near and around Arab villages and Bedouin encampments. Since the fruit is very tasty, Bedouin children, as well as other children and occasionally adults, tend to eat large amounts of pear, without any other food. The soft pulp is digested in the gastrointestinal tract and the seeds reach the colon. After water absorption the faecal mass consists of a dense matrix of innumerable seeds mixed with small amounts of faeces. Spontaneous defecation is impossible because of severe rectal pain aggravated by a “mechanical” proctitis. We recommend eating no more than Ž ve fruits at any one time, preferably after a main meal. It is important to