Introduction
Bezoars and polyps are an uncommon cause of mechanical intestinal obstruction. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Signs and symptoms classically vary from abdominal pain to constipation, nausea, vomiting, and abdominal distension. We present a rare case of impending perforation along with an intraluminal polyp near ileocecal junction due to phytobezoar impaction.
Case presentation
Our patient was a 59-year-old Sindhi female with a known history of interstitial lung disease and hypertension who presented to the emergency department with complaints of abdominal pain and constipation for 1 week, vomiting for 5 days, and abdominal distension for 2 days. After a preoperative examination and her failure to respond to conservative therapy, she was taken to the operating room for exploratory laparotomy. A hard intraluminal mass was suspected to be obstructing the small bowel at the site of impending perforation. This mass was a phytobezoar along with an intraluminal polyp. Resection of the affected segment was performed, followed by ileoileal anastomosis, and a drain was left. The patient was discharged 1 week later and was found to be well with no complaints at 3 weeks follow-up.
Conclusions
Early diagnosis of bezoars is important for early intervention and prevention of complications. Our case is unique as phytobezoar with intraluminal polyp is a rare clinical finding. Moreover, the signs and symptoms with which the patient presented are nonspecific and can be seen with multiple surgical emergencies.
Background
Bochdalek hernia is the most common type of congenital diaphragmatic hernia (CDH) resulting from postero-lateral diaphragmatic defect. Hepatic heterotopia is very rarely associated with CDH, and hepatic herniation favors the worst prognosis.
Case presentation
We present a case of a neonate diagnosed with right Bochdalek hernia (BH) with anomalous hepatic lobe heterotopia. Intra operatively, mal-rotated loops were also found to be herniating in the right hemithorax. The mal-rotated loops were reduced back into abdomen after performing Ladd’s procedure and diaphragmatic defect was repaired over the anomalous liver lobe. Baby was discharged on 7th postoperative day and follow-ups showed good recovery.
Conclusion
This case report discusses the presentation, classification, and significance of this association. Our case report is noteworthy as Bochdalek hernia is very rarely associated with anomalous hepatic lobe.
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