Social Media Challenge Gone Wrong: A Severe Case of Colonic Obstruction Secondary to Xylophagia and Literature Review.

Pica is characterized by the persistent craving and consumption of non-food substances. In some cases, individuals ingest paper-based materials, a behavior known as xylophagia, which may lead to gastrointestinal complications if the behavior becomes severe. Social media has recently been recognized as a potential influence on emerging patterns of unusual behaviors in adolescents, including those related to health and eating. We report this case to highlight the influence of social media on pica-related behaviors and its potential for life-threatening complications. We describe the case of an 18-year-old female with a past medical history of iron deficiency anemia and no formal psychiatric diagnosis, who developed a pattern of consuming tissue paper beginning around age 12. This behavior reportedly followed exposure to related content on social media and progressed to a compulsive pattern that led to colonic obstruction. At age 18, the patient required a right hemicolectomy due to an accumulation of undigested paper (xylobezoar). To our knowledge, this is the first reported case in which such a severe clinical outcome related to paper ingestion in an adolescent was directly associated with social media exposure. This case highlights how behavioral patterns observed online may contribute to high-risk ingestion behaviors in vulnerable individuals. Clinicians may benefit from incorporating questions about social media use when evaluating patients with unexplained gastrointestinal symptoms or nutritional deficiencies. Increased awareness of these emerging behavioral triggers can inform early identification and intervention strategies.