EP.FRI.248 The bezoar, the bowel, and the blockage: A rare case of a spontaneously passed phytobezoar

Abstract Background Bezoar, from the Persian meaning antidote, denotes a trapped mass in the gastrointestinal system. There are several types, but here we present a case of phytobezoar. A phytobezoar is one which is composed of undigestible plant material. While all bezoars account for less than 4% of intestinal obstruction, most occur within the stomach or small intestine. Phytobezoars causing large bowel obstruction appear to be extremely rare. Case report We present a case of a phytobezoar causing large bowel obstruction in a 29-year-old man. He presented with a four-day history of abdominal pain and distension with associated vomiting and no bowel opening. An abdominal X-ray demonstrated significant dilatation of transverse colon. Subsequent CT revealed large bowel obstruction with transition point in the distal sigmoid. An intraluminal lesion, with mottled appearance, containing locules of gas – a phytobezoar – was noted as the cause. The Patient was clinically well with no peritonism and planned for a flexible sigmoidoscopy in the first instance. However, the patient went on to pass two large, hard bowel motions leading to significant resolution of symptoms. A flexible sigmoidoscopy was carried out to exclude other pathology and demonstrated that the obstruction had been relieved. Conclusion While it seems phytobezoar is an incredibly rare cause for large bowel obstruction, most of the literature suggests operative management of the problem by means of laparotomy and enterotomy. This case demonstrates the potential for conservative management and possibility for spontaneous resolution, despite emergency presentation.

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A case of colonic gallstone ileus with a spontaneous evacuation

Health Renaissance ◽

10.3126/hren.v9i1.4363 ◽

1970 ◽

Vol 9 (1) ◽

pp. 47-49 ◽

Cited By ~ 1

Author(s):

A Bajracharya ◽

OP Pathania ◽

S Adhikary ◽

CS Agrawal

Keyword(s):

Bowel Obstruction ◽

Large Bowel ◽

Gallstone Ileus ◽

Abdominal Distension ◽

The Elderly ◽

Large Bowel Obstruction ◽

High Morbidity ◽

Diagnostic Challenge ◽

History Of ◽

Spontaneous Evacuation

Colonic gallstone is an uncommon entity with a high morbidity and mortality due to various reasons. It remains a diagnostic challenge because of delayed and non-specific presentations, especially in the elderly population, often with multiple co-morbidities. We present a case of colonic gallstone ileus with spontaneous evacuation in a 67 years female who had a threeday history of intermittent bouts of colicky abdominal pain, vomiting , constipation and progressive abdominal distension, features of large bowel obstruction treated non operatively for 72 hours and passage of the stone spontaneously. Keywords: gallstone ileus; large bowel obstruction; colonic gallstone DOI: 10.3126/hren.v9i1.4363Health Renaissance, 2011: Vol.9 No.1:47-49

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Chronic Constipation in the Elderly: An Unusual Presentation of Colonic Dysmotility in an Elderly Patient

Case Reports in Surgery ◽

10.1155/2013/608505 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2

Author(s):

R. Peravali ◽

H. Kranenburg ◽

J. E. Martin ◽

N. Keeling

Keyword(s):

Elderly Patient ◽

Case Report ◽

Bowel Obstruction ◽

Large Bowel ◽

Chronic Constipation ◽

The Elderly ◽

Large Bowel Obstruction ◽

History Of ◽

Underlying Pathology ◽

Colonic Dysmotility

Introduction. Chronic constipation is common in the elderly, and often no underlying pathology is found. Primary colonic dysmotility has been described in children but is rare in the elderly.Case report.We present an 82-year-old female with long standing constipation presenting acutely with large bowel obstruction. Laparotomy and Hartman’s procedure was performed, and a grossly distended sigmoid colon was resected. Histology revealed a primary myopathic process.Conclusion.Primary colonic myopathy should be considered in elderly patients presenting with large bowel obstruction and a long preceding history of constipation, particularly when previous endoscopic examinations were normal.

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Pediatric sigmoid volvulus of an extremely long sigmoid colon with hypoganglionosis: a case report

Journal of International Medical Research ◽

10.1177/03000605211032429 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110324

Author(s):

Matjaž Horvat ◽

Marko Hazabent ◽

Marjan Sekej ◽

Milka Kljaić Dujić

Keyword(s):

Sigmoid Colon ◽

Bowel Obstruction ◽

Large Bowel ◽

Treatment Options ◽

Vascular Occlusion ◽

Abdominal Distension ◽

Large Bowel Obstruction ◽

Sigmoid Volvulus ◽

History Of

Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pediatric patients. This condition occurs when a redundant sigmoid loop with a narrow mesenteric base of attachment to the posterior abdominal wall rotates around its mesenteric axis. This situation might result in vascular occlusion and large bowel obstruction. There are only a few predisposing factors of sigmoid volvulus, such as a long-term history of constipation or pseudo-obstruction with an excessive sigmoid colon. Underlying hypoganglionosis can also lead to large bowel obstruction. There have only been two reported cases of hypoganglionosis with sigmoid volvulus, and both were in adults. Sigmoid volvulus usually presents with abdominal pain, nausea, vomiting, constipation and abdominal distension, an absence of stool, or the presence of melenic stool in the rectum. Initial treatment options are non-surgical for stable patients, although surgical management might be necessary. If sigmoid volvulus is not recognized and resolved, it may lead to serious complications and death. Pediatric sigmoid volvulus is frequently the fulminant type, and therefore, a decision about treatment must be prompt. We present an unusual pediatric case of an extremely long sigmoid colon with hypoganglionosis, which twisted and caused obstruction. This condition was resolved with surgical resection.

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Bowel Obstruction and Perforation as Emergency Presenting Sign of Colorectal Cancer with Peritoneal Carcinomatosis: A Case Report and Review

The Indonesian Journal of Gastroenterology Hepatology and Digestive Endoscopy ◽

10.24871/2132020235-240 ◽

2020 ◽

Vol 21 (3) ◽

pp. 235-240

Author(s):

Randy Adiwinata ◽

Linda Rotty ◽

Michael Tendean ◽

Bradley Jimmy Waleleng ◽

Fandy Gosal ◽

...

Keyword(s):

Colorectal Cancer ◽

Peritoneal Carcinomatosis ◽

Bowel Obstruction ◽

Large Bowel ◽

Bowel Perforation ◽

Colorectal Cancer Patient ◽

Large Bowel Obstruction ◽

Emergency Laparotomy ◽

History Of ◽

Colorectal Cancer Patients

Colorectal cancer patient may present with variable clinical presentation. In few cases, colorectal cancer may present as emergency such as uncontrollable gastrointestinal bleeding, large bowel obstruction and in rarer fashion is bowel perforation. Worse prognosis is linked with emergency presenting colorectal cancer. Peritoneal carcinomatosis may occur in 10-35% of colorectal cancer patients and may develop bowel obstruction along with the primary colorectal cancer. Here, we report a-62-year-old man presented with large bowel obstruction leading to perforation without known history of colorectal cancer before. On emergency laparotomy, we found colorectal cancer and peritoneal carcinomatosis as the underlying cause. Prompt diagnosis and urgent management is warranted to improve the prognosis.

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ACUTE LARGE‐BOWEL OBSTRUCTION PRE‐CIPITATED BY BARIUM X‐RAY EXAMINATION

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1964.tb109423.x ◽

1964 ◽

Vol 2 (13) ◽

pp. 503-506 ◽

Cited By ~ 6

Author(s):

MARK KILLINGBACK

Keyword(s):

Bowel Obstruction ◽

Large Bowel ◽

Large Bowel Obstruction ◽

X Ray

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Retrospective analysis of large bowel obstruction or perforation caused by oral preparation for colonoscopy

Endoscopy International Open ◽

10.1055/s-0043-106200 ◽

2017 ◽

Vol 05 (06) ◽

pp. E471-E476 ◽

Cited By ~ 2

Author(s):

Akihiro Yamauchi ◽

Shin-ei Kudo ◽

Yuichi Mori ◽

Hideyuki Miyachi ◽

Masashi Misawa ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Abdominal Pain ◽

Bowel Obstruction ◽

Bowel Preparation ◽

Large Bowel ◽

Large Bowel Obstruction ◽

Perioperative Mortality ◽

Oral Preparation ◽

History Of

Abstract Background and study aims Patients undergoing bowel preparation for colonoscopy are at risk of potentially severe adverse events such as large-bowel obstruction (LBO) and perforation. These patients usually need emergency surgery and the consequences may be fatal. Little is known about the risk factors for LBO and perforation in these circumstances. We sought to establish the natural history of LBO and perforation caused by oral preparation for colonoscopy. Patients and methods We retrospectively analyzed data from 20 patients with LBO or perforation associated with oral preparation for colonoscopy. All patients were treated at the Showa University Northern Yokohama Hospital (SUNYH) between April 2001 and December 2015. Drugs used for bowel preparation, age, sex, indication for colonoscopy, pathogenesis and treatment were recorded. Results Eighteen of the patients had LBO and 2 had perforation. Fourteen events occurred at SUNYH, which accounted for 0.016 % of patients who underwent bowel preparation during this period. Seventeen patients were symptomatic when the decision to undertake colonoscopy was made (including 7 who complained of constipation and 4 who complained of abdominal pain; 3e were asymptomatic). Nineteen patients ultimately required surgery, 13 within 3 days of presentation. Eleven patients ultimately required colostomy. There was no perioperative mortality in our cases. Conclusion Large bowel obstruction and perforation are rare events associated with oral preparation for colonoscopy, but frequently require surgery. Exacerbation of constipation might be a risk factor for LBO or perforation. Potentially catastrophic situations can be avoided by early detection and treatment.

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