The value of MSCT in evaluating the passability of bezoar by conservative treatment for bezoars-induced small bowel obstruction

Colon obstruction due to sunflower seed bezoar: A case report

INTRODUCTION

This case report aims to present a rare case of colon obstruction caused by a bezoar in a 15-year-old teenager. The significance of this case lies in the rarity of such obstructions and the necessity for early diagnosis and appropriate intervention to optimize patient outcomes.

PRESENTATION OF CASE

A 15-year-old teenager presented with colicky abdominal pain, abdominal distension, nausea, vomiting, and rectal bleeding for three days. Initial investigations yielded normal results, but a digital rectal examination and abdominal X-ray suggested colon obstruction. The patient underwent surgical consultation and emergent laparotomy, during which a bezoar was identified and successfully removed endoscopically. Colonoscopy revealed that the bezoar was composed of shelled sunflower seeds, which correlated with the patient's dietary history.

DISCUSSION

This case highlights the rarity of bezoars causing colon obstruction. Early recognition and appropriate intervention are crucial for optimizing patient outcomes and preventing complications associated with colon obstruction.

CONCLUSION

This report highlights the importance of considering bezoars as a differential diagnosis in patients with colon obstruction. Early identification and treatment can prevent serious complications and improve clinical outcomes.

Diagnostic accuracy of abdominal contrast-enhanced multi-slice spiral CT after oral diluted iodide in a time segment for gastrointestinal fistula in patients with severe acute pancreatitis

PURPOSE

To evaluate the diagnostic accuracy of abdominal contrast-enhanced multi-slice spiral CT after oral diluted iodide in a time segment (post-ODI ACE-MSCT) for gastrointestinal fistula (GIF) in severe acute pancreatitis (SAP).

MATERIALS AND METHODS

Patients with SAP who underwent both post-ODI ACE-MSCT and endoscopy/surgery from 2017 to 2023 were continuously retrospectively involved. Their demographic information and clinical features were recorded prospectively in an in-hospital database. Using endoscopy/surgery results as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of post-ODI ACE-MSCT for diagnosing GIF in SAP were calculated by a four-cell table. The consistency of the two diagnostic methods was evaluated by the Kappa test and McNemar's test.

RESULTS

Using endoscopy/surgery as the reference standard, a total of 86 cases were divided into the GIF group (N = 52) and the non-GIF group (N = 34). Among the 52 cases of GIF, 88.5% (46/52) cases had a positive result and 11.5% (5/52) cases had a negative result of post-ODI ACE-MSCT for GIF. Among the 34 cases of non-GIF, 2.9% (1/34) case had a positive result and 97.1% (33/34) cases had a negative result of post-ODI ACE-MSCT for GIF. Post-ODI ACE-MSCT had a sensitivity of 88.5% (95% CI 75.9%-95.2%), a specificity of 97.1% (95% CI 82.9%-99.8%), a positive predictive value of 97.9% (95% CI 87.3%-99.9%), a negative predictive value of 84.6% (95% CI 68.8%-93.6%), and an accuracy of 91.9% (83.4%-96.4%). The kappa value was 0.834, and P < 0.001 by McNemar's test. There were no significant differences in diagnostic test characteristics between the two modalities.

CONCLUSION

Post-ODI ACE-MSCT can diagnose GIF in SAP in a simple, noninvasive, and accurate way, and can provide earlier imaging evidence for clinical diagnosis and treatment.

"Bezoar Egg"-A Rare Cause of Small Bowel Obstruction

Small bowel obstruction is a frequent medical condition with various causes, the most common being postoperative adhesions, volvulus, intussusception, hernias, and tumors. A bezoar-induced blockage of the small intestine is a rare condition that accounts for approximately 4% of all small bowel obstruction cases. Herein, we present the case report of a 71-year-old patient with diffuse abdominal pain caused by a small bowel obstruction due to a calcified bezoar (bezoar egg) resulting from a post-radiation intestinal stricture. The patient underwent a small bowel excision with the extraction of the bezoar, after which a full recovery was made.

Bezoar-induced small bowel obstruction: a rare cause of a common problem

Small Bowel Obstruction (SBO) is one of the most common diagnoses that general surgeons encounter. Adhesive disease, hernia, and neoplasm are the most common causes. A more rare cause is bezoar. A 66-year-old female with a history of prior abdominal surgery presented with clinical concern for SBO. CT scan of the abdomen and pelvis demonstrated SBO with a transition point in the left lower abdomen. The patient failed nonoperative management and was taken to the operating room for exploration. On exploration, a segment of hemorrhagic jejunum was found with an intraluminal bezoar. SBO secondary to bezoar can be managed endoscopically or operatively depending on location and size of the stone. Operative intervention can vary between laparoscopic milking of the bezoar distally, enterotomy with stone extraction, or bowel resection and anastomosis. This case illustrates the importance of maintaining a broad differential for common surgical disease processes.

The role of computed tomography in enterolith causing small bowel obstruction: A case series

Intestinal obstruction caused by enteroliths is an uncommon medical condition. Timely detection of the presence of enteroliths and identification of their origin can guide clinical treatment. This study aimed to present the Computed Tomography (CT) features of enterolithic ileus confirmed by surgery in 7 patients. Seven patients with surgically confirmed enterolithic ileus who were admitted to our hospital between December 2013 and December 2022 were continuously enrolled, and an abdominopelvic CT examination was performed before surgery. The imaging characteristics were then analyzed. In the transition zone of all patients with intestinal obstruction, the sharply defined intraluminal masses were found. Three of them had gallstones and 4 had primary enteroliths. All 5 enteroliths in the 4 patients with primary enteroliths were in the proximal small intestine and were low-density with gas. Additionally, 3 gallstones were present in the distal small bowel, and calcifications were observed. Simultaneously, cholecystitis and secondary cholecystoduodenal fistula were observed in all 3 patients with gallstones. Compared to gallstones, primary enteroliths tend to be higher positioned, less dense, and accompanied by gas. CT examination is very important, as it allows accurate identification, location, diagnosis, and identification of complications of the different types of enteroliths to provide a basis for surgery.