An unusual cause of small bowel obstruction: duodenal bezoar-induced diverticulitis

Small bowel obstruction (SBO) secondary to enterolithiasis in the setting of small bowel diverticulosis is rare, and diagnosis can be challenging. Enteroliths may cause complications including diverticulitis, perforation, and obstruction, typically requiring surgical removal. An 83-year-old woman presented with abdominal pain, vomiting, and constipation. CT imaging demonstrated an intraluminal lesion at the duodenojejunal junction adjacent to an inflamed duodenal diverticulum, consistent with diverticulitis and partial SBO. Initial conservative management included nasogastric decompression, intravenous antibiotics, and parenteral nutrition. Serial imaging showed migration of the intraluminal mass to the proximal jejunum, but persistent obstruction prompted laparotomy and enterotomy, revealing an inspissated food bezoar. Enterolith-induced SBO and diverticulitis is an uncommon but important differential in elderly patients presenting with obstructive symptoms. While conservative management may be attempted in select patients, progression to surgery is frequently required. Early recognition and tailored management can improve outcome.