From Fiber to Obstruction: A Case of Small Bowel Obstruction Due to Phytobezoar

Phytobezoars, a rare cause of small bowel obstruction (SBO), account for 0.4%-4% of cases and are most commonly associated with altered gastric motility from prior gastric surgery or systemic conditions like diabetes mellitus and hypothyroidism. Phytobezoars form from indigestible plant fibers that resist enzymatic breakdown, and their incidence may increase in populations with high-fiber diets. Due to their nonspecific clinical presentation, prompt diagnosis requires a combination of clinical suspicion and imaging studies, particularly computed tomography (CT), by which characteristic intraluminal masses are identified.

A case is presented of a 48-year-old female with a history of partial gastrectomy for peptic ulcer disease who presented with abdominal pain, nausea, vomiting, and distension. Tenderness and hyperactive bowel sounds consistent with mechanical obstruction were found on examination. A mottled gas-containing mass in the jejunum, suggestive of a phytobezoar, was identified by CT imaging. Laparotomy was performed, and an enterotomy was carried out to extract the bezoar. Postoperative recovery was uneventful, and dietary counseling was provided to prevent recurrence.

Phytobezoars are an uncommon but important cause of SBO, particularly in patients with risk factors such as prior gastric surgery or high-fiber diets. Awareness of this condition is crucial for timely diagnosis and management. Surgical intervention remains the mainstay of treatment for complete obstructions, while postoperative dietary counseling and management of underlying conditions are essential to prevent recurrence. The need for heightened clinical awareness to minimize complications associated with phytobezoar-induced SBO is underscored by this case.