Tangled culprit: a rare case of bezoar-induced small bowel obstruction with pulmonary Edema in a rural Guatemalan woman

Abstract

We present the unusual case of a 52-year-old woman from a low-resource community in Guatemala who developed small bowel obstruction, followed by acute pulmonary edema. The patient had no prior history of abdominal surgeries or significant comorbidities, making this presentation unexpected. The obstruction was caused by a bezoar and complicated by fluid overload during resuscitation. Radiologic findings revealed dilated bowel loops, suggesting bowel obstruction, and Kerley B lines, indicating concurrent pulmonary edema. This report underscores the challenges of managing complex emergencies in resource-limited settings, highlighting the importance of timely surgical intervention and careful fluid management.

Keywords: Critical care medicine; Emergency medicine; Gastroenterology; Respiratory disorders.

Figure 1

Imaging studies demonstrating ‘Stack of Coins’ sign in small bowel obstruction. A: Plain abdominal radiograph, the abdominal X-ray shows dilated loops of small bowel with visible, closely packed valvulae conniventes, forming the characteristic ‘stack of coins’ appearance. B: Axial CT scan of the abdomen, this contrast-enhanced abdominal CT scan further confirms the small bowel obstruction, with dilated loops filled with gas and fluid.

Figure 2

Chest radiograph showing signs of pulmonary Edema. A: Anteroposterior (AP) chest X-ray, this AP chest radiograph demonstrates diffuse interstitial opacities, predominantly in the lower lung fields, consistent with pulmonary edema. Notably, Kerley B lines (white arrows) are visible along the periphery of the lungs. B: Lateral chest X-ray, the lateral view further highlights fluid accumulation along the interlobular septa, contributing to the Kerley B lines.