Small Bowel Obstruction Induced by Phytobezoar: A Case Report in Innocent Abdomen and Literature Review

Abstract

Introduction: Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. Herein, we report a case of small bowel obstruction (SBO) following excessive consumption of wild grapes with no previous abdomen medical or surgical history. Presentation of case: A 65-year-old male farmer presented with cessation of materials and gas associated with vomiting of food and then bilious. The abdomen was bloated and painful on palpation with a moving, painful mass in the left iliac fossa. The hypothesis of acute occlusion of the colon was retained and confirmed on the X-Ray which showed a dilation of small bowel with air-fluid levels. The diagnostic of acute SBO was retained. We performed urgently a median laparotomy. We found the dilation of the loops from the jejunum to the sigmoid colon with a compact mass at the sigmoid colon of 15 cm in length and 6 cm in diameter. We proceeded to crush the mass that was made up with wild grape seed fecal, and push it back to the rectum. The phytobezoar made up with wild grape seeds was extracted through the anus with the fingers after anal dilation.

Small Bowel Obstruction Caused by a Shiitake Mushroom: A Case Report

“…The phytobezoars are the most common type of bezoars to cause bowel obstruction. They are aggregates of indigested food material (vegetables or fibers) in the gastrointestinal tract, especially in the stomach and in the narrowest locations of the small bowel loop (i.e., 50-100 cm proximal to the ileocecal valve) or at the valve itself [2,5,7]. The shiitake mushroom (Lentinus edodes) is a rare type of phytobezoar which has a rich source of insoluble fiber and causes difficult digestion, which may lead to intestinal obstruction if the whole piece of the mushroom is ingested.…”

“…Small bowel obstruction secondary to bezoar impaction is much less common, with a reported frequency of around 4%, and is rarely diagnosed preoperatively [1][2][3]. Phytobezoar is a type of bezoar comprising an aggregate of indigestible vegetables or fibers in the gastrointestinal tract [1,2,4,5]. Shiitake mushroom is full of insoluble dietary fiber, uneasy to ingest in an uncut form, soft and slimy and can lead to accidental swallowing, especially in an aged person without teeth [6][7][8].…”