Obstruction with a Patent Lumen

Abstract

Purpose: Psyllium is one of the most commonly used fiber supplements worldwide. There have been case reports of esophageal and intestinal bezoars mass obstruction from psyllium use. A 60 year old male with no history of dysphagia presented with a globus sensation few minutes after taking his daily psyllium supplement. He was unable to swallow solids or liquids. Endoscopy revealed a material bonded to the surface just distal to the oropharynx continuous to the gastro esophageal junction. The material had glue like gelatinous appearance, circumferentially adherent to the underlying mucosa. The lumen of the esophagus remained patent with no mass obstruction. The patient had immediate resolution of symptoms after the procedure. At follow-up endoscopy, there was complete passage of material. Exam revealed a normal mucosa without strictures, rings or abnormalities of peristalsis. Psyllium and Plantago Ovata. In 1986, the FDA recommended dividing doses of psyllium supplements and addended their report in 2007, listing intestinal obstruction as a side effect of granular forms of psyllium. This modification, however, specifically states that this listing does not apply to psyllium powder. This patient illustrates the first published case report of obstruction by coating of the esophagus from the powdered form of psyllium. Physicians should be aware of psyllium use in patients presenting with obstruction.Figure: Psyllium powder coating the esophagus.Figure: Psyllium powder coating the esophagus.