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Olayinka R Ibrahim, Abubakar S Lugga, Nuraddeen Ibrahim, Lawal M Ibrahim, Bello M Suleiman Department of Pediatrics, Federal Medical Centre, Katsina, Katsina State, Nigeria Background: Despite a high prevalence of iron-deficiency anemia (IDA) in developing countries such as Nigeria, intestinal obstruction secondary to lithobezoar (an accumulation of ingested stones within the gastrointestinal tract) is uncommon. Case presentation: Herein, we report a case of acute intestinal obstruction secondary to ingestion of large pebbles and IDA in a 5-year-old Nigerian boy. The patient was managed conservatively with the use of laxatives and a rectal wash-out, and the pebbles were excreted over 3 days. Oral iron therapy was also commenced with cessation of pica. Discussion: Although the direction of causal relationship between pica and IDA remains debatable, routine screening for iron deficiency among children with lithobezoar is recommended. Besides managing complications associated with lithobezoar, such as intestinal obstruction, prompt initiation of iron therapy among those who present with features of iron deficiency may be beneficial. Keywords: lithobezoar, iron-deficiency anemia, intestinal obstruction, child