Phytobezoar-induced small bowel obstruction in an elderly patient undergoing dialysis: a case report

Abstract

A phytobezoar is defined as an accumulation of poorly digested fruit and vegetable fibers in the gastrointestinal tract. Phytobezoar-induced small bowel obstruction is an uncommon entity and is usually removed surgically. We herein describe an elderly man undergoing dialysis who developed a phytobezoar because of excessive consumption of high-fiber fruits and inappropriate chewing. His potential predisposing factors were dialysis-related lifestyle changes, reduced activity levels, fluid restriction, and gastrointestinal motility dysfunction; however, he had no history of gastric surgery. The patient’s clinical history and characteristic imaging features aided in the diagnosis. He underwent medical treatment, and his recovery was uneventful. This case highlights the importance of an awareness of phytobezoar-induced small bowel obstruction in patients at increased risk of developing bezoars and demonstrates that this condition can occur in the absence of previous gastric surgery. We believe that elderly patients undergoing dialysis are at increased risk of developing bezoars. Excessive consumption of a strictly fibrous diet and insufficient chewing exacerbate the risk. A detailed dietary history and imaging features can aid in early diagnosis, leading to appropriate medical or surgical care. Surgical treatment is not inevitable in all cases. Individualized dietary suggestions in these patients are important for effective preventive control.

A Rare Cause of Small Bowel Obstruction: A Case Report

“…Finally, it shows complete intestinal obstruction ( 7 ). Early diagnosis of fecalith intestinal obstruction is difficult, and in order to improve the correct diagnosis rate, the following points should be noted ( 8 , 9 ): (1) detailed information about the presence of lithogenic foods, such as persimmons, before the onset of the disease, as it is of great help in the diagnosis of fecaliths and their causes; (2) The disease should be highly suspected in incomplete intestinal obstruction with mild initial abdominal pain, insignificant abdominal distension, mildly hyperactive or normal bowel sounds, relatively long-lasting disease, no previous surgical history, and no usual change in stool habits; (3) Abdominal X-ray examination is the basic method to diagnose intestinal obstruction, but the sensitivity of diagnosing small intestinal obstruction is low, and the cause and location of obstruction cannot be accurately determined, so the clinical application value for diagnosing the cause of obstruction is low; (4) Fecalith has a more specific performance in B ultrasound examination, but it is more difficult to locate the location of fecalith of intestinal obstruction due to the interference of gas in the intestinal cavity, so the clinical use and reference value are not better than CT; and (5), CT examination is the main examination modality for the diagnosis of this disease, and abdominal CT has important clinical value for the localization and qualitative diagnosis of fecalith intestinal obstruction. The CT diagnostic accuracy of this disease is 89.94%, and the typical CT signs include dilated and empty intestinal migratory luminal fecal ball sign with CT values of 40–80 Hu and air-containing dense spots within the mass.…”