Small bowel obstruction due to phytobezoar: CT diagnosis

Ko, Sheung‐Fat; Lee, T.-Y.; Ng, Shu Hang

doi:10.1007/s002619900240

Cited by 51 publications

(40 citation statements)

References 3 publications

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“…Similar to previous reports [4][5][6][7], the bezoars determined in the present study were typically intraluminal ovoid or round mottled-appearing masses with soft-tissue density and air in their interstices. These typical CT findings were observed in three patients in the present series.…”

Section: Discussionsupporting

confidence: 77%

“…Small bowel feces appear more amorphous than defined and affect longer segments without an encapsulating wall [4]. By contrast, small bowel bezoars are well-defined, focal, ovoid, intraluminal masses with mottled gas patterns at the obstruction site [4,5,11]. Moreover, small bowel bezoars are typically found at the transition zone between dilated and collapsed small bowel loops, whereas small bowel feces appear to be in dilated small bowel loops [12].…”

Section: Discussionmentioning

confidence: 99%

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Computed Tomography Findings of Small Bowel Obstruction due to Bezoar Impaction: A Case Series

Xu¹

2012

Emergency Medicine

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IntroductionIntestinal obstruction is one of the most perplexing clinical situations encountered by a surgeon in the emergency room. Computed tomography (CT) has become the most useful and powerful tool in diagnosing intestinal obstructions. CT was reported to yield sensitivities of 81% to 96%, with up to 96% specificity and 95% accuracy for the diagnosis of small bowel obstruction (SBO) [1]. The most common cause of SBO is adhesions. Bezoars are by far one of the most uncommon causes. Bezoars are not commonly diagnosed preoperatively unless calcified. In this study, we describe non-enhanced CT findings of intestinal obstruction secondary to bezoars. Materials and MethodsBetween March 2011 and November 2011, CT scans of four patients (two males and two females with an age range of 49 to 86 years) diagnosed with SBO due to bezoars were reviewed. All patients underwent non-enhanced CT without an oral contrast agent because contrast-enhanced CT was not routinely preformed in our hospital. All the CT scans were obtained using 64-slice MDCT scanners. The scanning parameters were as follows: contiguous 2.5 mm collimation, 12.5 mm/0.5-second table speed per 360° gantry rotation with a resultant pitch value of 1.25, and 5.0 mm thick slices secondarily reconstructed at 1.0 mm intervals (Aquilion 64, Toshiba, Japan), or 0.625 mm detector collimation, 2.0 mm slice thickness, and 1.0 mm reconstruction intervals (Brilliance 64, Philips, Netherlands). All CT scans of each patient were analyzed by two experienced abdominal radiologists on the picture archiving and communication system (PACS) workstation (Neusoft PACS, China). ResultsClinical, demographic, and non-enhanced CT findings of the four patients are presented in the subsequent sections. Case 1A 62-year-old male presented with a week of abdominal pain and distention. CT of the abdomen showed distended small bowel loops with air-fluid levels. At the transition zone of the ileum, a mottled intraluminal mass (3.1 cm×2.8 cm×4.5 cm) was found with soft-tissue density containing air bubbles in its interstices (Figure 1). The bowel wall was thickened at the obstructed site. Ascites were also detected. Considering the possibility of bezoar formation with underlying bowel carcinoma, conventional laparotomy was implemented. The thickened ileal wall was finally identified as an oppressive edema caused by bezoar impaction. Case 2An 86-year-old male was admitted with 3 days of right lower AbstractBackground: This study presents computed tomography (CT) findings of small bowel obstruction due to bezoar impaction.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Computed Tomography Findings of Small Bowel Obstruction due to Bezoar Impaction: A Case Series

Xu¹

2012

Emergency Medicine

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“…Differentiation from small bowel feces, found in chronic SBO, may be difficult. Encapsulation, rounded configuration of mass, wall thickening and mesenteric edema at the site of the mass are more likely to be associated with phytobezoar [32,33].…”

Section: Obturation Obstruction Due To Bezoarmentioning

confidence: 96%

“…They are more likely to occur in patients following gastric bypass procedures, and patients are routinely warned against eating seeded fruit following surgery. The commonest site of obstruction by a phytobezoar is proximal jejunum [32]. Phytobezoar have a fairly classic appearance on CT (Fig.…”

Section: Obturation Obstruction Due To Bezoarmentioning

confidence: 99%

Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery

et al. 2004

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Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction.

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“…Primary small bowel bezoars are very rare and may cause acute abdomen due to SBO (1, (13,14). DBE is a safe, feasible diagnostic tool that allows high-resolution endoscopic imaging and total enteroscopy, and provides the capability of obtaining tissue for histological studies (3,15).…”

Section: Discussionmentioning

confidence: 99%