High Intestinal Obstruction Secondary to Phytobezoar. A Rare Cause of Acute Abdomen: Case Report
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Abstract
Introduction: Bezoars are rare accumulations of indigestible material in the gastrointestinal tract. Phytobezoars, formed from plant fibers, can cause small bowel obstruction, even without classic risk factors such as prior gastric surgery. This report presents a case of high intestinal obstruction due to phytobezoar in an otherwise healthy patient.
Case Presentation: A 55-year-old man presented with severe colicky abdominal pain (VAS 8/10), nausea, vomiting, and abdominal distension. Contrast-enhanced CT revealed distal ileal obstruction with a heterogeneous intraluminal mass. Conservative management with nasogastric decompression failed due to high output and feculent vomiting. Laparoscopy showed a 10 × 7 × 6 cm phytobezoar (vegetable fibers and seeds) 50 cm proximal to the ileocecal valve. Enterotomy, extraction, primary closure, and lavage were performed without resection. The patient recovered uneventfully and was discharged on postoperative day 7.
Discussion: Phytobezoars commonly obstruct at the terminal ileum and are linked to delayed gastric emptying or high-fiber intake, though primary small bowel cases occur without predisposing factors. CT is the gold standard for diagnosis (high sensitivity/specificity). Surgical enterotomy is effective when conservative measures fail.
Conclusion: Phytobezoar should be considered in acute intestinal obstruction, even without risk factors. Prompt CT imaging and individualized surgical extraction provide efficient resolution.
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