We report a case of small bowel occlusion due to the formation of a bezoar around a knot at the distal end a gastro-jejunal catheter used for continuous levodopa/carbidopa intestinal gel (LCIG) in a patient with advanced Parkinson’s disease. The patient presented with a history of abdominal pain and vomiting starting 24 h before admission and frequent failure of his LCIG device for the past week. Small bowel occlusion along with a knot formation on the distal catheter was confirmed by contrast enhanced CT scan. After failure of endoscopic extraction, the patient was taken to theater. The presence of a knot and a bezoar was confirmed and extraction proceeded via transverse enterotomy without the need for bowel resection. Despite inhalation pneumonia and prolonged ileus, the patient recovered fully. LCIG treatment was reinstated a month later through new gastro-jejunal catheter. This case highlights a severe and surprising complication of LCIG treatment.

A 52-year-old woman developed atraumatic splenic rupture 1 week after appendectomy for perforated appendicitis. The emergency computed tomography (CT) revealed abscessed appendicitis. We performed a laparoscopic appendectomy and meticulous peritoneal lavage of the right lower quadrant peritonitis. Intravenous antibiotics were prolonged after surgery. Six days after appendectomy, she presented acute signs of hypotensive shock associated with abdominal pain and blood in the pelvic drain. Emergency CT scan revealed splenic rupture with major hemoperitoneum and active splenic bleeding. Embolization of the splenic artery was initially successful, but she relapsed into shock a few hours later. We proceeded to splenectomy. Pathological examination only found inflammation. She was discharged 1 month after the initial operation. Spontaneous splenic rupture is a rare but life-threatening complication of appendicitis with major peritonitis. It must be identified and treated immediately. Colic microbiota could be responsible of acute splenitis and congestion after a bacteremia.