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

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.

Colonic Endometriosis: A Study of Near Obstructing Sigmoid Endometrioma

A 41-year-old woman had a near-obstructing endometrioma involving the distal sigmoid colon treated with en bloc removal of the involved segment of colon and the adherent adnexa.

Ileo-colonic tubular duplication with distal sigmoid colon stenosis in a neonate: A case report

Background: Though the duplication cysts presenting with intestinal obstruction are not uncommon in neonates, tubular duplications may pose a significant diagnostic and management challenge. Case Presentation: We present the successful management of a neonate presenting with intestinal obstruction. The diagnosis of ileocolonic tubular duplication cyst was made intra-operatively. The cyst was managed with a novel technique. Conclusion: Tubular duplications of the alimentary tract rarely encounter in neonates. The surgeons should improvise the surgical technique to manage such anomalies.

Laparoscopic colectomy in idiopathic colonic varices: a safe endeavour

A 32-year-old man presented to the emergency department with recurrent episodes of haematochezia and haemodynamic instability. He had no complaints of alteration in bowel habits or mucus discharge in the stool. He was a non-smoker and does not consume alcohol. After stabilising the patient, clinical evaluation and investigations with gastrointestinal endoscopy revealed dilated and tortuous submucosal veins involving the entire colon excepting the distal sigmoid. CT angiography and Doppler ultrasonography revealed normal patency and flow in the mesenteric vessels as well as hepatic, portal vein and inferior vena cava. With the exclusion of the secondary causes, we made the diagnosis of the rare entity of idiopathic colonic varices. He underwent a laparoscopic colectomy with ileorectal anastomosis, without any additional technical challenges intra-op and had an uneventful postoperative recovery. Idiopathic colonic varices can be a differential diagnosis of gastrointestinal bleeding and one can safely proceed with laparoscopic colectomy.