An apricot story: view through a keyhole

Abstract

Background: Very few cases of small bowel obstruction due to ingested fruits have been described in literature, and most of these have managed by a laparotomy. Laparoscopic assisted surgery can effectively deal with such impacted foreign bodies, thereby avoiding a formal laparotomy.

Case presentation: A 75 years old lady was admitted via the Accident and Emergency to the surgical ward with a three-day history of abdominal pain and vomiting. Investigations were suggestive of acute small bowel obstruction. On laparoscopy, there was an area of sudden change in calibre of small bowel with dilated proximal and collapsed distal segment in distal jejunum. A foreign body, dried undigested apricot, was extracted by mini-laparotomy.

Discussion: Small bowel obstruction is a frequent cause of emergency surgery, and aetiology may include food bolus obstruction. Diagnosis is usually confirmed intra-operatively. Foreign body impacted in small bowel can be removed by open or laparoscopic methods.

Conclusion: Generally, laparotomy is performed for diagnosis and management in acute bowel obstruction, but with increasing expertise, laparoscopy can be equally effective with all the other advantages of minimal access approach.

Figure 1

Abdominal X-Ray on the day of A&E admission showing small bowel dilation.

Figure 2

Emergency CT scan showing small bowel dilation with a point of abrupt change in calibre and angulation in the distal jejunal loop. The small bowel distal to this point was collapsed.

Figure 3

A view through laparoscope: showing dilatation of the distal jejunum with intraluminal body causing obstruction.

Figure 4

Dilated jejunum delivered through minilaparotomy.

Figure 5

A foreign body, dried undigested apricot, was extracted through jejunum.

Figure 6

Post-operative Barium meal follow-through showing no pathology in the small intestine with passage of contrast into the colon. The contrast reached the terminal ileum after ninety minutes.