An unusual case of phytobezoar-induced small bowel obstruction

Small bowel obstruction on food impaction after binge eating

Small bowel obstruction is a relatively prevalent surgical condition, with the most common underlying cause being postoperative adhesions. However, in patients with no previous history of abdominal surgery, one needs to think more outside the box. In this case study, we have a young and athletic man who presented to the emergency department with an acute abdomen, shortly after binge eating a large amount of food. Obstruction due to food impaction, such as in our case, should always be on the differential list, especially in those without significant medical history and with binge eating pattern where uncontrolled and extreme amounts of food are eaten alternating with restrictive dieting.

A Rare Cause of Small Bowel Obstruction: A Case Report

INTRODUCTION

Small bowel obstruction is a common surgical emergency abdominal condition in clinical practice. Fecalith is one of the rare causative factors, especially phytobezoars.

CASE REPORT

We report the case of a 66-year-old man admitted with "abdominal pain with vomiting for 1 day." Enhanced CT of the abdomen suggested incomplete small bowel obstruction. The symptomatic treatment with fasting, fluid replacement, gastrointestinal decompression, and antibiotics was conducted after the patient was admitted to the hospital. After 2 days of treatment, the patient's abdominal pain was not significantly relieved, so a decision was made to perform laparoscopic examination surgery. During surgery, a columnar foreign body was found embedded in the lumen of the small intestine about 10 cm away from the ileocecal region. Combined with the patient's preoperative history of consuming a large number of persimmons, the primary diagnosis of small intestinal fecalith obstruction was considered. We performed an enterotomy to remove the foreign body, and the procedure was uneventful. On postoperative day 7, the patient was successfully discharged.

CONCLUSION

When we encounter a patient with intestinal obstruction without a history of surgery in our clinical work, we should take a careful history, especially about the consumption of foods that can cause phytoliths. When a patient has consumed a large amount of food that can cause phytobezoars before the abdominal pain, we should diagnostically consider it as phytobezoars intestinal obstruction, which helps to reduce the incidence of misdiagnosis and allows the patient to receive treatment timely and effectively.

A Chicken Bone as an Unusual Cause of Bezoar-Induced Small Bowel Obstruction: A Case Report

Bezoars are a rare and often overlooked cause of small bowel obstruction, arising from an accumulation of indigestible foreign material, often being plant-based in origin. The majority of these cases arise in a predictable patient subgroup. The author presents an unusual case of a small bowel obstruction arising from a chicken bone encased in feculent material in a patient with no classical risk factors for bezoar formation.

Phytobezoar: A train can hide another

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A very rare cause of acute intestinal obstruction without diagnostic peculiarities.

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The patient's particular profile and his past medical history should mainly guide the diagnosis.

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The abdominal CT scan can improve the diagnosis, but it should not delay management.

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Exploring the entire digestive tract intraoperatively is an imperative procedure that can be life-saving.

Introduction and importance

Acute bowel obstruction is a life-threatening condition; late or incomplete management worsens the prognosis. Bezoars are a rare etiology of this disease, and the diagnosis can be confusing. This study aims to present and discuss a very rare case of concomitant bezoars.

Case presentation

We report the case of a 22-year-old male with a history of mental retardation who was admitted to the emergency department for acute intestinal obstruction with diffuse abdominal guarding. Laboratory findings revealed a biological inflammatory syndrome and an electrolyte imbalance. The abdominal X-ray was without abnormalities. Intraoperatively, a phytobezoar in the jejunum was initially discovered. However, the entire digestive tract's meticulous exploration discovered a concomitant vegetable bezoar in the stomach.

Clinical discussion

Phytobezoar obstruction is very rare and usually located in the distal small bowel, related to the reduced intraluminal diameter, the decreased mobility, and the higher water absorption in this portion. The clinical presentation is non-specific and reflects acute intestinal obstruction in the majority of cases. The abdominal CT-scan is useful for diagnosis. However, Surgeons should not delay the intervention until they recognize the etiology preoperatively because it is not always obvious. Besides, surgeons should explore the entire gastrointestinal tract during the intervention; a second phytobezoars' location is undoubtedly exceptional but exists, as evidenced by our case.

Conclusion

When phytobezoar obstruction, urgent care is required, and the intraoperative exploration of the entire digestive tract is a simple gesture with capital importance. It allows to prevent avoidable complications, especially a second surgery.