CT findings in patients with small bowel obstruction due to phytobezoar

Abstract

The role of CT in evaluating patients with small bowel obstruction (SBO) has been extensively described in the current literature. We present the CT findings of SBO due to a phytobezoar, afterwards surgically confirmed, in 5 men and 1 woman (aged 32-89 years) out of 95 patients diagnosed by CT as having SBO in a 44-month period. These six patients underwent abdominal CT prior to operation and the CT findings were retrospectively reviewed. All six patients presented with clinical symptoms and signs of SBO; three of them had undergone gastric surgery 13, 17, and 22 years earlier, respectively. In all six cases, CT showed an ovoid intraluminal mass, 3 x 5 cm in size and of a mottled appearance, at the transition zone between dilated and collapsed small bowel loops. This was in contrast to feces-like material (the "small bowel feces sign"), seen within dilated small bowel loops in nine patients with SBO, and was typically longer. As CT is frequently performed for suspected SBO, an ovoid, short intraluminal mottled mass seen at the site of an obstruction may be regarded as a pathognomonic preoperative sign of an obstructing phytobezoar.

Obstruction of Small Bowel Caused by Unconscious Trichotillomania: Rapunzel Syndrome

“…Small bowel bezoars are sometimes confused with feces; however, small bowel bezoars can be discriminated in that small bowel feces occupy a relatively long segment of a dilated small intestine. 3 Although, the patient's history of trichotillomania was unknown at presentation, the definitive diagnosis of Rapunzel syndrome was made solely based on the CECT findings in the present case. The huge oval mass with a large amount of air in the stomach was characteristic of a trichobezoar.…”

An Obstructing Small Bowel Phytobezoar in an Elderly Female Nigerian: A Case Report and Literature Review

“…Plain abdominal X-ray showing evidence of mechanical small bowel obstruction can be seen in most patients but is not specific. Abdominal computed tomography (CT) scan is 90% sensitive and 57% specific in excluding other differential diagnoses of bezoar-induced ileus [7]. According to Zissin et al [7], faecal matter in the small bowel on abdominal CT may appear like a bezoar.…”

“…Abdominal computed tomography (CT) scan is 90% sensitive and 57% specific in excluding other differential diagnoses of bezoar-induced ileus [7]. According to Zissin et al [7], faecal matter in the small bowel on abdominal CT may appear like a bezoar. Unlike bezoar, impacted faeces tend to appear in a longer transition zone of dilated segment of small bowel proximal to the site of obstruction.…”

Gastric Diospyrobezoar Mimicked Acute Appendicitis: A Case Report

“…Bezoar treatment consists of medical treatment, surgery, and endoscopic procedures. Patients with minor symptoms profit from medication therapy by enzymes (19). Cellulase is the only medical treatment of the symptoms, but bowel obstruction followed by this treatment is a complication effect due to bezoar dissolution passing through the stomach and trapping in the intestines (20).…”

“…Endoscopic procedures are used for crushing and suction of mass. For larger diospyrobezoars, gastrotomy or laparoscopic procedures are suggested (7,19). Tools such as CT scans, endoscopic evaluation, and abdominal ultrasonography could help to determine diagnosis.…”