Pumpkin Seed Bezoar Causing Lower Gastrointestinal Bleeding

A 38-year-old woman with no significant past medical history presented to the emergency department with a 1-day history of diffuse abdominal pain. She reported normal bowel movements up to 1 day prior and was unable to pass anything rectally since. There was no report of fever, nausea, vomiting, hematemesis, or melena. Physical exam demonstrated diffuse abdominal tenderness and normal bowel sounds. Laboratory evaluation was unremarkable, and a computed tomography scan of the abdomen and pelvis showed fecal impaction without evidence of obstruction (Figure 1). She was initially treated with tap water enemas without improvement. In the following 24 hours, the patient reported several episodes of hematochezia with a drop of 4.2 g/dL hemoglobin.