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Case Report: Seaweed Bezoar Masquerading as a Malignant Obstruction
1New York-Presbyterian/Queens, Weill Cornell Medical College, Flushing, NY 11355, USA.
Case Reports in Surgery
|December 5, 2018
Summary
Phytobezoars are rare causes of small bowel obstruction (SBO). This case highlights a seaweed phytobezoar mimicking malignancy, emphasizing the need for high suspicion in diagnosis.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Small bowel obstruction (SBO) is uncommon, with bezoars being a rare etiology.
- Nonoperative management options for bezoars include endoscopic dissolution, with surgery reserved for persistent obstruction.
Observation:
- A case of an Asian woman presenting with acute-on-chronic abdominal pain after seaweed ingestion.
- Initial CT scan suggested malignant small bowel obstruction with liver metastases, later resolved on further imaging.
- Laparotomy revealed a seaweed phytobezoar causing obstruction, with a distal mild stricture.
Findings:
- The patient underwent successful surgical resection of the affected small bowel segment.
- Intraoperative liver ultrasound ruled out metastases, and pathology confirmed a benign stricture.
- Contrast-enhanced CT showed high sensitivity but low specificity for bezoar identification.
Implications:
- Bezoar-related SBO diagnosis can be delayed, especially with confounding factors like apparent hepatic lesions.
- A high index of suspicion is crucial for diagnosing bezoars, particularly in at-risk patients.
- This case underscores the importance of considering bezoars in SBO differential diagnosis, even when imaging suggests malignancy.
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