A 71-year-old man with a history of distal gastrectomy (Billroth-I reconstruction) presented to our hospital with frequent vomiting and was hospitalized. On the third day after admission, an upper endoscopy showed gastric bezoars in the descending portion of the duodenum, hence we performed endoscopic lithotripsy, but it failed to achieve complete crushing, and cola dissolution therapy was initiated via the gastric tube. Similarly, on the eighth day after admission, we performed an additional endoscopic lithotripsy but failed to achieve complete crushing. An ileus tube was then placed and cola dissolution therapy was continued. On the eleventh day after admission, the patient complained of abdominal pain, and abdominal CT scan revealed that ascites appeared around the liver and the bezoars had migrated to the distal jejunum. Further conservative treatment was considered difficult, so the bezoars were removed by performing an emergency surgery. There are reports suggesting that surgery for intestinal obstruction caused by bezoars could be avoided by dissolution therapy with cola via an ileus tube, while other reports indicate that intestinal necrosis may occur during dissolution therapy. Therefore, it is important to carefully judge the indications for dissolution therapy and not miss the timing of surgery.
