Obstruction due to small bowel bezoar

Case contributed by Dr Servet Kahveci

Presentation

The patient had vague abdominal complaints for the past three months to which was added dyspepsia, nausea and vomiting on the last day.

Patient Data

Age: 60 years
Gender: Male

CT shows a mottled gas-patterned intragastric mass suspicious of a bezoar. There is similar appearing in the fourth part duodenum. Notice the dilated stomach and duodenal loops. Jejunal and ileal loops are normal.

CT shows a mottled gas-patterned intragastric mass suspicious of a bezoar (yellow arrow).

There is similar appearing in the fourth part duodenum (red arrow).

Dilated duodenal loops (blue arrow).

Ultrasound

At follow up US examination two days later:

The first image: Gray-scale sonogram shows arc-like surfaced intragastric mass (yellow arrow) with a strong posterior acoustic shadow. Notice the dilated stomach (red arrow).

The second image: Gray-scale sonogram shows arc-like surfaced intrajejunal mass (white arrow) with a strong posterior acoustic shadow. Notice the dilated jejunal loops (black arrow). At CT examination the bezoar was in duodenum. 

The photograph shows the bezoars extracted via laparotomy. Thanks to Dr Hüseyin Kayaoğlu for the photo.

Case Discussion

Bezoars are accumulations of indigestible contents within the gastrointestinal tract. Bezoars are known to cause small bowel obstruction and sometimes CT may demonstrate the bezoar as a mass in the obstructed segment of bowel. However, US examination can serve as follow-up for patients who were suspected of having a bezoar-induced small bowel obstruction.

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Case information

rID: 59583
Published: 15th Apr 2018
Last edited: 19th Apr 2018
Inclusion in quiz mode: Included
Excluded from licensing
Institution: Sevgi Private Hospital

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