Gastric and intestinal phytobezoar with incomplete intestinal obstruction

Case contributed by Mohamed Saber ◉

Diagnosis certain

Citation, DOI, disclosures and case data

Citation:

Saber M, Gastric and intestinal phytobezoar with incomplete intestinal obstruction. Case study, Radiopaedia.org (Accessed on 01 Oct 2023) https://doi.org/10.53347/rID-84738

DOI:

https://doi.org/10.53347/rID-84738

Permalink:

https://radiopaedia.org/cases/84738

rID:

84738

Disclosures:

At the time the case was submitted for publication Mohamed Saber had no recorded disclosures.

View Mohamed Saber's current disclosures

Case published:

4 Dec 2020

Revisions:

4 times, by 1 contributor - see full revision history and disclosures

Systems:

Gastrointestinal

Institution:

Faculty of medicine Al-Azhar University

Quiz mode:

Included

Presentation

Abdominal pain and distension. The pain was intermittent and relieved by analgesics

Patient Data

Age: 25 years

Gender: Male

Initial non-enhanced CT study

From the case: Gastric and intestinal phytobezoar with incomplete intestinal obstruction

Non- enhanced CT study shows moderate dilatation of the stomach with intraluminal two gas-containing ovoid bodies initially presumed to be food residues. Moderate dilatation of the small bowel loops with another similar gas- containing ovoid body seen intraluminal within an ileal loop (review annotated images). Mild intraperitoneal free fluid is also noted

The patient followed conservative treatment with stationary intermittent pain and distension. He passed profuse watery diarrhea. Due to stationary symptoms, further contrast-enhanced CT was done.

Follow up contrast-enhanced CT study after 2 days

From the case: Gastric and intestinal phytobezoar with incomplete intestinal obstruction

Contrast-enhanced CT study shows the same findings noted in the previous study with still visualized intragastric and ileal gas containing bodies. The previous consideration of food residues is now questionable. A confusing collapsed bowel loop cluster at the left para duodenal region is also noted

The patient still under conservative treatment. NGT was inserted however the pain is still present and distension is stationary. Follow up non-enhanced CT was done

Follow up non-enhanced CT after 2 days

From the case: Gastric and intestinal phytobezoar with incomplete intestinal obstruction

Follow up non-enhanced CT study shows stationary gastric and small bowel dilatation with intra-gastric questionable bodies. The ileal mass-like body moved to the left iliac fossa.

The patient's clinical status became worse and the imaging findings were not definite. The multidisciplinary team decided exploratory laparotomy

Intra-operative

From the case: Gastric and intestinal phytobezoar with incomplete intestinal obstruction

Photo

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Intraoperative: multiple gastric and small bowel semi-soft foreign bodies were found, removed, and sent for histopathology that revealed:

Specimen Type: Foreign bodies

Clinical History: Intestinal obstruction by foreign bodies

Macroscopic: Specimen received without formalin with patient identification and file number and labeled as, intestinal foreign bodies, consisting of 4 pieces of abnormal foreign bodies, semi-soft, greenish colored, each measuring about 5x5x3cm. The cut section reveals yellowish friable tissue.

Microscopic: Sections show material of plant origin with no evidence of malignancy.

Diagnosis: Intestinal obstruction by foreign bodies, removed for biopsy. Foreign bodies of plant origin with no evidence of malignancy.

From the case: Gastric and intestinal phytobezoar with incomplete intestinal obstruction

Annotated image

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Annotated images highlight gastric and intestinal phytobezoars in the initial (red color), first follow up (yellow color), and last follow up (green color) CT studies

Case Discussion

Bezoar refers to special food or foreign body that is not digested in the alimentary tract with subsequent conglomeration and formation of mass-like lesions that are occasionally causing gastric /intestinal obstruction. It may be of plant"phytobezoar", hair "trichobezoar" or drug "pharmacobezoar" nature.

Intraluminal pathologies should be considered while searching for the cause of intestinal obstruction. However, suspicion of phytobezoar is occasionally difficult on imaging especially if small and multiple due to the great similarity to food residues and particles in addition to unhelpful clinical history, as it is just undigested food compared to trichobezoar and pharmacobezoar where the clinical history is often helpful. Stationary visualization of these bodies on follow-up imaging may be a helpful clue however the degree of confidence occasionally remains low.

Intraoperative photos contribution by Dr/ Adel Abdelwahed

1 article features images from this case

Bezoar

Gastric and intestinal phytobezoar with incomplete intestinal obstruction

Citation, DOI, disclosures and case data

Presentation

Patient Data

Initial non-enhanced CT study

Follow up contrast-enhanced CT study after 2 days

Follow up non-enhanced CT after 2 days

Intra-operative

Case Discussion

1 article features images from this case

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Gastric and intestinal phytobezoar with incomplete intestinal obstruction

Citation, DOI, disclosures and case data

Presentation

Patient Data

Initial non-enhanced CT study

Follow up contrast-enhanced CT study after 2 days

Follow up non-enhanced CT after 2 days

Intra-operative

Case Discussion

1 article features images from this case

14 public playlists include this case

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