Phytobezoar: A train can hide another. (April 2021) - Mejri, Atef
Highlights: A very rare cause of acute intestinal obstruction without diagnostic peculiarities. The patient's particular profile and his past medical history should mainly guide the diagnosis. The abdominal CT scan can improve the diagnosis, but it should not delay management. Exploring the entire digestive tract intraoperatively is an imperative procedure that can be life-saving. Abstract: Introduction and importance: Acute bowel obstruction is a life-threatening condition; late or incomplete management worsens the prognosis. Bezoars are a rare etiology of this disease, and the diagnosis can be confusing. This study aims to present and discuss a very rare case of concomitant bezoars. Case presentation: We report the case of a 22-year-old male with a history of mental retardation who was admitted to the emergency department for acute intestinal obstruction with diffuse abdominal guarding. Laboratory findings revealed a biological inflammatory syndrome and an electrolyte imbalance. The abdominal X-ray was without abnormalities. Intraoperatively, a phytobezoar in the jejunum was initially discovered. However, the entire digestive tract's meticulous exploration discovered a concomitant vegetable bezoar in the stomach. Clinical discussion: Phytobezoar obstruction is very rare and usually located in the distal small bowel, related to the reduced intraluminal diameter, the decreased mobility, and the higher water absorption in this portion. The clinical presentation is non-specific and reflects acute intestinal obstruction in the majority of cases. The abdominal CT-scan is useful for diagnosis. However, Surgeons should not delay the intervention until they recognize the etiology preoperatively because it is not always obvious. Besides, surgeons should explore the entire gastrointestinal tract during the intervention; a second phytobezoars' location is undoubtedly exceptional but exists, as evidenced by our case. Conclusion: When phytobezoar obstruction, urgent care is required, and the intraoperative exploration of the entire digestive tract is a simple gesture with capital importance. It allows to prevent avoidable complications, especially a second surgery.