Phytobezoar: A train can hide another.

Area of Science:

• Gastroenterology
• Surgical Case Reports
• Abdominal Surgery

Background:

• Acute bowel obstruction is a critical condition with increased risks from delayed management.
• Bezoars, rare causes of obstruction, can present diagnostic challenges.
• This report details an exceptionally rare case of multiple, concomitant bezoars.

Observation:

• A 22-year-old male with a history of mental retardation presented with acute intestinal obstruction.
• Initial intraoperative findings revealed a jejunal phytobezoar.
• Further exploration identified an additional vegetable bezoar within the stomach.

Findings:

• Phytobezoar obstruction typically occurs in the distal small bowel due to anatomical factors.
• Clinical presentation is often non-specific, mimicking general acute intestinal obstruction.
• Abdominal CT scans can aid diagnosis, but preoperative identification of all bezoars is not always feasible.

Implications:

• Urgent surgical intervention is necessary for phytobezoar-induced obstruction.
• Thorough intraoperative exploration of the entire gastrointestinal tract is essential.
• This practice can prevent secondary surgeries and improve patient outcomes by identifying all bezoars.