Abstract
Primary small bowel bezoars are rare and cause acute abdomen due to small bowel obstruction (SBO). A 69-year-old Japanese man presented with epigastric pain associated with fullness. Physical examination of the abdomen showed no marked signs of peritoneal irritation. An erect X-ray film of the abdomen showed small bowel obstruction. Computed tomography (CT) showed a dilated small bowel loop proximal to the site of the obstruction. Retrograde double balloon enteroscopy (DBE) was performed and showed yellow, hard bezoars blocking the distal ileum. At surgery, a bezoar was found impacted in the distal ileum, and enterotomy with extraction was performed. After 9 days, the patient was discharged from our hospital in satisfactory condition. DBE also appears to be a safe and useful diagnostic tool in patients with SBO, and the findings of DBE influence the strategy of therapy in patients in whom the cause of SBO could not be determined by conventional radiography.
Highlights
Bezoars are an uncommon cause of small bowel obstruction (SBO) and are usually concretions of foreign material found in the stomach
Bezoars usually become impacted in the narrowest potion of the small bowel, which is 50–75 cm proximal to the ileocecal valve, or at the valve itself [2]
Bezoars are usually found in the stomach, but they may pass into the small bowel [3]
Summary
A Case of Small Bowel Obstruction Caused by Bezoars Diagnosed with Double Balloon Enteroscopy. Primary small bowel bezoars are rare and cause acute abdomen due to small bowel obstruction (SBO). Physical examination of the abdomen showed no marked signs of peritoneal irritation. An erect X-ray film of the abdomen showed small bowel obstruction. Computed tomography (CT) showed a dilated small bowel loop proximal to the site of the obstruction. Retrograde double balloon enteroscopy (DBE) was performed and showed yellow, hard bezoars blocking the distal ileum. A bezoar was found impacted in the distal ileum, and enterotomy with extraction was performed. DBE appears to be a safe and useful diagnostic tool in patients with SBO, and the findings of DBE influence the strategy of therapy in patients in whom the cause of SBO could not be determined by conventional radiography
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