Surgical and Endoscopic Treatment of a Double Phytobezoar Causing Ileus and Jaundice: A Case Report

Bezoars are rare conditions of mechanical intestinal occlusion. Among the various types of bezoars, phytobezoars and trichobezoars are the most common types. Symptoms are usually indistinguishable from other more common entities; therefore, it may be difficult to reach a correct diagnosis. Computed tomography (CT) scan is the preferred diagnostic method. Treatment may include surgery, lavage with Coca-Cola or hydrolytic solutions, and endoscopic mechanical or electrical disintegration. The present case report aimed to describe an uncommon symptomatic double phytobezoar (ileal and gastric), which was successfully treated surgically and endoscopically. The patient, an 83-year-old woman, was admitted to the General Hospital of Drama (Drama, Greece) after suffering from abdominal pain for 3 days. Physical examination revealed abdominal distention and pain mainly in the right quadrants. The CT scan revealed an intestinal phytobezoar which was subsequently removed surgically with a longitudinal enterotomy. On the third postoperative day, the patient presented jaundice and a new CT scan showed a second phytobezoar impacted into the duodenal bulb, which was missed during the initial diagnosis. The gastric phytobezoar was fragmented endoscopically using a polypectomy snare with high flow electric current (70-80 Watts) and its pieces were removed orally. The patient had no complications during the hospital stay and was discharged on the eighth postoperative day. Three months later, the follow-up gastroduodenoscopy and CT scan revealed no signs or symptoms of any gastrointestinal mass. The present case report is the first presentation of a double gastrointestinal phytobezoar that caused ileus and temporary jaundice. Moreover, a successful single-session mechanical-electrical fragmentation of a large gastric phytobezoar is described for the first time.