Small Intestinal Obstruction Caused by a Bezoar in an Elderly Patient

Abstract

Small bowel obstruction caused by phytobezoars is quite uncommon in patients suffering from acute abdomen. The most common causes of small bowel obstruction are adhesive bands, incarcerated hernia, and adjacent tumor. We present a rare case of phytobezoar-induced small bowel obstruction in a female elderly patient without a history of abdominal surgery. An 83-year-old female presented to our emergency department on 5 March 2008 with intermittent vomiting and abdominal pain. After failure of conservative treatment with nasogastric tube decompression and a prokinetic agent, abdominal computed tomography (CT) with contrast was arranged on March 9, 2008. The CT scan showed marked dilatation of the jejunum with fluid retention and possibly a large calcified bezoar (2.7cm × 3.16cm) causing obstruction at the ileum. Surgery was performed on March 13, 2008, and the pathologic report showed a fibrocalcified nodule. Based on this case, we have suggest that bezoar-induced small bowel obstruction remains possible even in patients with no history of gastric surgery, autonomic enteropathy, or recent intake of persimmons. Surgical intervention is the standard management for intestinal bezoars, and early diagnosis and intervention reduces morbidity and mortality.