Intestinal bezoar aggravated by hypomotility of ischemic small intestine: A case report

Abstract

There is limited literature on the subject of intestinal bezoars in the setting of small bowel ischemia. Furthermore, no evidence‐based pathogenesis has been offered in current case reports. This report describes a unique case of small bowel ischemia with simultaneous bezoar aggravation in the small intestine. An 82‐year‐old woman with a history of diabetes mellitus and hyperlipidemia presented with intermittent severe postprandial abdominal pain over the last 2 days. An upper endoscopy 3 weeks prior revealed a gastric bezoar approximately 1.5 cm in diameter. However, during this visit, the gastric bezoar was not visible upon repeat upper endoscopy. A plain abdominal X‐ray was ordered and revealed patterns consistent with small bowel ileus. Upon further investigation, an abdominal computed tomography revealed mid‐ileum vessel delayed arterial enhancement and dilatation of the proximal ileum. This finding is consistent with intestinal ischemia‐induced congestion and bowel obstruction. Bowel perforation was also suspected. A subsequent laparoscopic surgery revealed a bezoar at the level of bowel ischemia. The bezoar was removed and the ischemic segment was resected. Coexistence of intestinal bezoar and small bowel ischemia is rare. Based on the patient's clinical evidence and published experimental evidence, we hypothesized that intestinal ischemia predisposes a patient to intestinal hypomotility, causing bezoar aggravation or formation in the small intestine. Early treatment of gastric bezoars and consideration of bowel ischemia risk due to atherosclerosis are crucial to minimizing bezoar complications.