An Unusual Small Bowel Phytobezoar Successfully Resolved by Double-balloon Enteroscopy

Area of Science:

• Gastroenterology
• Digestive Diseases
• Surgical Endoscopy

Background:

• Small bowel obstruction is a common surgical emergency.
• Phytobezoars, indigestible masses of plant matter, can cause obstruction.
• Bracken fern consumption is an uncommon but reported cause of phytobezoars.

Observation:

• A 69-year-old woman presented with nausea and vomiting due to small bowel obstruction.
• Computed tomography identified an air-filled foreign body in the jejunum.
• Double-balloon enteroscopy confirmed a phytobezoar as the cause.

Findings:

• The phytobezoar was successfully fragmented and removed using endoscopic snare fragmentation.
• This endoscopic approach avoided the need for surgical intervention.
• The patient's symptoms resolved following the procedure.

Implications:

• Endoscopic snare fragmentation is a viable, minimally invasive treatment for phytobezoar-induced small bowel obstruction.
• This technique may reduce patient morbidity associated with surgical interventions.
• Awareness of dietary triggers like bracken fern is crucial for preventing phytobezoar formation.