# Avoid the Peel: Citrus Fruit Bezoar Causing Intestinal Perforation

## TL;DR

An 86-year-old man suffered intestinal perforation after eating unpeeled kumquats, requiring emergency surgery to remove damaged bowel.

## Contribution

Reports a rare case of intestinal injury caused by citrus fruit ingestion leading to perforation and peritonitis.

## Key findings

- Unpeeled kumquats caused fibrous exudates and ulceration in the small intestine.
- Emergency surgery was required to remove non-viable bowel and the obstructing mass.
- The patient recovered well post-surgery with no further complications.

## Abstract

We report a highly unusual case of small bowel obstruction in an 86-year-old man from ingestion of a citrus fruit, known as kumquats, which led to intestinal perforation and peritonitis. He initially presented with a one-day history of diffuse abdominal pain associated with nausea and feculent emesis after eating whole pieces of unpeeled kumquats. When symptoms of peritonitis evolved with a blood lactate of 5.1 mg/dL, he was urgently taken to the operating room for exploration. Multiple areas with fibrous exudates and full-thickness ulceration were encountered along the distal jejunum and proximal ileum, with a partially obstructing intraluminal mass in the distal ileum. Treatment involved resection of 70 cm of non-viable bowel, removal of the intraluminal mass, and surgical re-establishment of intestinal continuity. Unpeeled kumquats were confirmed to have caused these intestinal findings. The patient did well following the operation and has had no further problems referred to by this management.