Foodborne botulism presenting as small bowel obstruction: a case report

Abstract

Background: Small bowel obstruction is one of the leading reasons for accessing to the Emergency Department. Food poisoning from Clostridium botulinum has emerged as a very rare potential cause of small bowel obstruction. The relevance of this case report regards the subtle onset of pathognomonic neurological symptoms, which can delay diagnosis and subsequent life-saving treatment.

Case presentation: A 24-year-old man came to our Emergency Department complaining of abdominal pain, fever and sporadic self-limiting episodes of diplopia, starting 4 days earlier. Clinical presentation and radiological imaging suggested a case of small bowel obstruction. Non-operative management was adopted, which was followed by worsening of neurological signs. On specifically questioning the patient, we discovered that his parents had experienced similar, but milder symptoms. The patient also recalled eating home-made preserves some days earlier. A clinical diagnosis of foodborne botulism was established and antitoxin was promptly administered with rapid clinical resolution.

Conclusions: Though very rare, botulism can mimic small bowel obstruction, and could be associated with a rapid clinical deterioration if misdiagnosed. An accurate family history, frequent clinical reassessments and involvement of different specialists can guide to identify this unexpected diagnosis.

Keywords: Botulism; Case report; Clostridium botulinum; Foodborne botulism; Small bowel obstruction.

Fig. 1

Abdominal X-rays showing small bowel distension with air-fluid levels

Fig. 2

CT scan with intravenous contrast showing small bowel distension with air-fluid levels, and a reduced distal ileum diameter in the right iliac fossa

Fig. 3

Neurological signs. a Mydriasis. b Ptosis