A case of intestinal obstruction caused by bezoars fragmented endoscopically

Abstract

The number of cases of bezoar have increased recently with advances in upper gastrointestinal endoscopy. Some patients require surgical treatment due to intestinal obstruction, while treatment by endoscopy has been reported in many cases. We experienced a case of small bowel obstruction due to the fragments of a crushed bezoar. A 93-year-old woman was admitted to our hospital with upper abdominal discomfort. Computed tomography and upper gastrointestinal endoscopy revealed a 5-cm bezoar in the second part of the duodenum. The bezoar was endoscopically crushed into fragments using a grasping forceps and snare ; however, the bezoar fragments caused small bowel obstruction after 27 days. Despite conservative treatment, small bowel obstruction did not improve ; therefore, we performed an operation. The fragments of bezoar were impacted in the ileum, and we resected this segment of the ileum, including bezoars. We report that careful examination is important after crushing bezoars, because the bezoar fragments cause small bowel obstruction.