DOI: http://dx.doi.org/10.18203/2349-2902.isj20205421

A fruity bowel obstruction: ingested dehydrated apple as a cause for small bowel obstruction

Daniel Page, Emilia Dauway

Abstract


Small bowel obstructions are common acute surgical presentations often as a result of intraabdominal adhesions or herniations; rarer causes include malignancies, strictures, foreign bodies and bezoars. Phytobezoars (bezoars composed of undigested plant material) account for<4% of small bowel obstructions. Here we report an unusual case of a 56-year-old male with a virgin abdomen presenting with a small bowel obstruction, a CT scan of his abdomen and pelvis was suggestive of a closed loop small bowel obstruction. The patient progressed to have an emergency laparotomy and was found to have multiple intraluminal obstructing foreign bodies within the distal ileum. On making an enterotomy to remove and examine these, they were found to be rehydrated apple segments that the patient had ingested in the dehydrated form several hours earlier. This is an example of a phytobezoar causing bowel obstruction, contributing factors to the occurrence of these include poor gastrointestinal motility and problems of mastication; in this instance the patient had poor dentition that likely pre-disposed him to this problem.


Keywords


Small bowel obstruction, Phytobezoar, bezoar, Dehydrated fruit, Apple, Acute abdomen

Full Text:

PDF

References


Jenkins JT, Pring ET, Malietzis G. Small bowel obstruction, viewed September 2020. Accessed on 20 July 2020.

Teng HC, Nawawi O, Ng KL, Yik YI. Phytobezoar: an unusual cause of intestinal obstruction. Biomedic Imag Intervent J. 2005;1(1).

Chisholm EM, Leong HT, Chung SC, Li AK. Phytobezoar: an uncommon cause of small bowel obstruction. Ann Roy Col Surgeo Engl. 1992;74(5):342.

Moseley RV. Pyloric obstruction by a phytobezoar following a pyloroplasty and vagotomy. Arch Surg. 1967;94:290-1.

Pujar AK, Pai SA, Hiremath BV. Phytobezoar: A Rare Cause of Small Bowel Obstruction. J Clin Diagn Res. 2013;7(10):2298–9.

Ooi S, Hong K. Small bowel obstruction caused by dried apple. Int J Surg. 2015;10:154-7.

Delabrousse E, Lubrano J, Sailley N, Aubry S, Mantion GA, Kastler BA. Small-bowel bezoar versus small-bowel feces: CT evaluation. Am J Roentgenol. 2008;191(5):1465-8.

Piotto L, Gent R. Dried apricots: an unusual cause of bowel obstruction. Pediat Radiol. 2005;35(12):1224-6.

Eng K, Kay M. Gastrointestinal bezoars: history and current treatment paradigms. Gastroenterol Hepatol. 2012;8(11):776.