Abstract
Phytobezoars are a rare cause of small bowel obstruction. Such cases are most commonly associated with previous abdominal surgery or poor dentition or psychiatric conditions. A 40 year old man with a virgin abdomen and excellent dentition and no underlying psychiatric condition presented with an acute abdomen. CT scan revealed a transition point between dilated proximal loops of small bowel and collapsed distal loops. Exploratory laparotomy revealed a phytobezoar unable to be milked into the cecum and an enterectomy with primary anastamosis was performed without complication. A detailed history revealing several less common predisposing factors for phytobezoars should increase clinical suspicion of a phytobezoarinduced small bowel obstruction in the setting of an acute abdomen. Vigilance in presentations of an acute abdomen improves the usefulness of medical imaging, such as a CT, to detect phytobezoars. Understanding mechanisms of phytobezoar formation helps guide management and may prevent surgery.
Highlights
A 40 yearold man presented to the Emergency Department (ED) with a twoday history of abdominal pain
His pain was associated with nausea and vomiting. His last bowel movement was one day prior to presentation, but he was passing flatus in the ED. His past medical history was significant for diabetes, hypertension, and hepatitis C
Phytobezoars are undigested vegetable in the gastrointestinal system and a rare cause of small bowel obstruction [1,2] typically associated with prior abdominal surgery and poor dentition [3,4,5]
Summary
Manning1,*, Vikram Vattipallly, Masooma Niazi, and Ajay Shah2 1Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA 2Department of Surgery, Bronx Lebanon Hospital, Bronx, NY, USA 3Department of Pathology, Bronx Lebanon Hospital, Bronx, NY, USA
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