Purpose or Case Report: Bezoars are an uncommon cause of small bowel obstruction (SBO) in children. Trichobezoars are typically seen in adolescent girls who swallow their hair. Lactobezoars are another unusual cause of intestinal obstruction in neonates/infants. Phytobezoars, foreign body bezoars and pharmacobezoars are other types of bezoars. CT is a useful tool in diagnosing the cause of SBO, however, SBO caused by bezoars may not be detected on a CT exam as it presents as faeces like material proximal to the transition point. Ultrasound (US) can help differentiate a bezoar from faeces. The diagnostic signs of a bezoar on US include an echogenic, arc-like surfaced intraluminal mass, strong posterior acoustic shadowing and twinkling artefacts from the front of the mass resulting from the rough hard surface and high acoustic impedance differences within the internal structure of a bezoar. These features are not seen with faecal material.

We present two cases of bezoar induced SBO. The first case was a small intestinal trichobezoar in an 11 year old female child who presented with abdominal pain and bilious vomiting since 4 days. US demonstrated dilated small bowel with classic appearances of a bezoar in distal ileum. CT was not done in this instance and patient underwent surgery based on US findings. Same patient was also shown to have a large gastric bezoar on further endoscopic and ultrasound evaluation. Second case was a lactobezoar in a 9 month old infant that presented with copious bilious aspirates in NG tube, post difficult hernia reduction. CT demonstrated acute SBO with transition point at IC junction and faeces like intraluminal material proximal to it. US again showed characteristic appearances of a bezoar thus clinching the diagnosis. First patient underwent extraction via enterotomy and the second patient was treated with fragmentation and milking out.

Our cases highlight following learning points: 1. US shows characteristic appearances and improves diagnostic accuracy in conjunction with CT thus helping radiologists to quickly and easily diagnose bezoar. US can also suffice as first line and only imaging investigation needed. 2. Lactobezoar should be kept as a differential for SBO in neonates/infants. 3. In cases of intestinal bezoars, possibility of further proximal/gastric bezoars must be explored.
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