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Small bowel obstruction with multiple perforations post chestnut ingestion.
Raevin K Ravindra1, Atandrila Das1, Grace L Chew1
1Department of General Surgery, Northern Health, Epping, Victoria, Australia.
BMJ Case Reports
|February 6, 2019
Summary
Phytobezoars, solidified plant matter, rarely cause small bowel obstruction. This case highlights potential for severe small bowel trauma and perforation, necessitating thorough gastrointestinal inspection.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Phytobezoars, concretions of indigestible plant material, are an uncommon etiology for small bowel obstruction (SBO).
- Obstruction arises from accumulation of seeds, skins, and fibers from fruits and vegetables.
Observation:
- A 61-year-old male presented with acute abdominal pain, nausea, and vomiting.
- CT imaging revealed SBO with a transition point.
- Laparoscopy identified multiple small bowel perforations from jejunum to ileum.
Findings:
- Surgical exploration revealed undigested chestnuts as the phytobezoar.
- The phytobezoar caused extensive small bowel trauma and multiple perforations.
- The patient underwent laparotomy with removal of the bezoar and repair of perforations.
Implications:
- This case underscores the potential for phytobezoars to induce significant small bowel injury, including perforation.
- Thorough intraoperative examination of the entire gastrointestinal tract is crucial in managing phytobezoar-related SBO.
- Early recognition and management are vital to prevent severe complications.
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