A Case of Small Bowel Obstruction Caused by Bezoars Diagnosed with Double Balloon Enteroscopy

Abstract

Primary small bowel bezoars are rare and cause acute abdomen due to small bowel obstruction (SBO). A 69-year-old Japanese man presented with epigastric pain associated with fullness. Physical examination of the abdomen showed no marked signs of peritoneal irritation. An erect X-ray film of the abdomen showed small bowel obstruction. Computed tomography (CT) showed a dilated small bowel loop proximal to the site of the obstruction. Retrograde double balloon enteroscopy (DBE) was performed and showed yellow, hard bezoars blocking the distal ileum. At surgery, a bezoar was found impacted in the distal ileum, and enterotomy with extraction was performed. After 9 days, the patient was discharged from our hospital in satisfactory condition. DBE also appears to be a safe and useful diagnostic tool in patients with SBO, and the findings of DBE influence the strategy of therapy in patients in whom the cause of SBO could not be determined by conventional radiography.

Clinical Characteristics and Treatment Outcomes of Nineteen Japanese Patients with Gastrointestinal Bezoars

“…Although several bezoar case series have been reported from Western countries (3)(4)(5)(6) and South Korea (7), only single case reports or small case series describing a few Japanese patients are available, to our knowledge (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In Japan, the epidemiology and etiology of bezoars have not been fully elucidated, and treatment is empirical.…”

An Unusual Small Bowel Phytobezoar Successfully Resolved by Double-balloon Enteroscopy

“…Small bowel obstruction is usually caused by band adhesions or common hernias and is very rarely caused by foreign bodies or bezoars ( 8 ). The clinical symptoms of small bowel obstruction of bezoars include nausea, vomiting, abdominal pain, a fever, and an elevated white blood cell count ( 1 , 5 ). Bezoars are aggregated poorly digested fibers of fruits and vegetables in the gastrointestinal tract ( 1 , 5 ).…”

“…The clinical symptoms of small bowel obstruction of bezoars include nausea, vomiting, abdominal pain, a fever, and an elevated white blood cell count ( 1 , 5 ). Bezoars are aggregated poorly digested fibers of fruits and vegetables in the gastrointestinal tract ( 1 , 5 ). Bracken, called Warabi , is a widely eaten wild vegetable in Japan.…”

“…The development of double-balloon enteroscopy (DBE) in 2001 (2) made active endoscopic observation and endoscopic treatment of the entire small bowel feasible. However, reports of endoscopic treatment of small bowel bezoars are rare, with only five cases reported to date (1,(3)(4)(5)(6).…”

Phytobezoar-Induced Small-Bowel Obstruction Successfully Diagnosed and Treated by Single-Balloon Enteroscopy

“…1 As reported, only 3 cases of bezoar-induced, small-bowel obstruction have been treated successfully by balloonassisted enteroscopy, 2-4 although another 2 were failed for re-obstruction after treatment. 5,6 To ensure success, we fragmented the phytobezoar into as small pieces as possible and injected 5% sodium bicarbonate solution, which can dissolve the phytobezoar into loose structures by mucolytic effect, 1 into the lumen. In addition, oral liquid paraffin and an enema given after treatment were used to prevent re-obstruction.…”