2026 Volume 46 Issue 3 Pages 468-471
A 75-year-old man presented with a week’s history of abdominal pain and vomiting. Abdominal computed tomography revealed a foreign body in the small intestine and dilatation of the proximal intestine, based on which he was diagnosed as having small bowel obstruction due to an impacted foreign body and immediately admitted. Decompression with a long intestinal tube failed, and urgent surgery was performed. A foreign body was identified 110 cm from the terminal ileum and removed via enterotomy. The patient’s postoperative course was satisfactory and he was discharged on postoperative day 8. No recurrence has been noted until date, 6 months after the procedure. The foreign body was identified as a phytobezoar. Gastric bezoars are insoluble aggregates of undigested food and foreign substances in the stomach, and phytobezoars are extremely common in Japan. Factors that predispose to bezoar formation include impaired gastric emptying following gastrectomy or diabetic neuropathy, while inadequate mastication has also been reported as a factor. In this case, inadequate mastication following hemimandibulectomy for ameloblastoma and consumption of high-fiber foods were considered as having caused the bezoar formation. In cases of bowel obstruction among patients with inadequate mastication, an impacted bezoar should be considered as a leading differential diagnosis.
