Adrenal Crisis Secondary to Small Bowel Obstruction Caused by a Bezoar

Bezoars are aggregates of undigested materials that accumulate in the gastrointestinal lumen. They are a rare cause of small bowel obstruction and are mostly diagnosed in patients with small bowel disease. Patients with panhypopituitarism are more susceptible to developing metabolic and haemodynamic instability, particularly during perioperative period. We present the case of a male patient with small bowel obstruction secondary to a bezoar. The patient was admitted to the hospital due to upper abdominal pain and emesis, presenting with clinical signs of shock. He had a history of iatrogenic panhypopituitarism and had been submitted to a bilateral inguinal hernioplasty 15 days before. Abdominopelvic computed tomography with angiography revealed small bowel obstruction secondary to a bezoar. Stress-dose hydrocortisone was administered to treat the underlying haemodynamic instability, followed by exploratory laparotomy. The bezoar was removed and eventually the patient recovered with a tapering regimen of hydrocortisone. The diagnosis of small bowel obstruction secondary to bezoar can be challenging. The shock could be related to an adrenal crisis precipitated by the bezoar in the setting of increased susceptibility due to the recent surgery.