A rare cause of small bowel obstruction due to bezoar in a virgin abdomen

Abstract

Introduction: Bezoar is an unusual cause of small bowel obstruction accounting for 0.4-4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum.

Case report: A 28-year-old male with no past surgical history, known to have severe mental retardation presented with anorexia. CT scan demonstrated dilated small bowel loops and intraluminal ileal mass with mottled appearance. At exploratory laparotomy, a bezoar was found impacted in the terminal ileum 5-6 inches away from the ileocecal valve and was removed through an enterotomy.

Discussion: Bezoars are concretions of fibers or foreign bodies in the alimentary tract. Small bowel obstruction is one of common clinical symptoms. The typical finding of well-defined intraluminal mass with mottled gas pattern in CT scan is suggestive of an intestinal bezoar. The treatment option of bezoar is surgery including manual fragmentation of bezoar and pushing it toward cecum, enterotomy or segmental bowel resection. Thorough exploration of abdominal cavity should be done to exclude the presence of concomitant bezoars. Recurrence is common unless underlying predisposing condition is corrected.

Conclusions: Bezoar-induced small bowel obstruction remains an uncommon diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, a history suggestive of increased fiber intake, or patient with psychiatric disorders. CT scan is helpful for preoperative diagnosis.

Keywords: Bezoar; Computed tomography; Intestinal obstruction.

Fig. 1

Plain abdomen X-ray demonstrating multiple dilated small bowel loops, with moderate amount of stool throughout the colon.

Fig. 2

CT with oral and intravenous contrast demonstrating dilated intestinal loops and a mass with a mottled gas pattern suggestive of bezoar (arrow).

Fig. 3

CT with oral and intravenous contrast demonstrating a collapsed ileal loop (arrow) distal to the bezoar.

Fig. 4

The bezoar was a pair of crumbled wrinkled almost desiccated light tan thin translucent plastic gloves, obstructing 5–6 in. proximally from the ileocecal valve.