A Bezoar Causing Bowel Obstruction After Roux-en-Y Gastric Bypass: A Case Report

  • Alireza Tavassoli Department of General Surgery, Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Mehrdad Fakhlaei Department of General Surgery, Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Fatemeh Sadat Abtahi Mehrjardi Department of General Surgery, Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Mehrdad Gazanchian School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Keywords: Gastric bypass, Bezoar, Intestinal obstruction

Abstract

We aimed to present a patient with phytobezoar causing small bowel obstruction after Roux-en-Y gastric bypass. Thirty-year-old woman with a history of prior Roux-en-Y gastric bypass due to morbid obesity three years ago presented with colicky abdominal pain, distention, nausea, vomiting, and obstipation. Initial abdominal X-ray showed various distended small bowel loops with air-fluid levels. The patient was taken to operation room for laparoscopic exploration, and a phytobezoar was found in distal jejunum. The bezoar was fragmented and flushed through cecum. The patient tolerated the surgery and her symptoms relieved without complication. Moreover, she received dietary consultation in order to prevent future recurrences. Small bowel obstruction in a patient with prior abdominal surgery is mainly caused due to adhesions, stenosis of anastomosis and hernias. An uncommon cause for obstruction is bezoar formation. The majority of patients with bezoars have a history of gastric surgery. Diagnostic imaging is not always helpful, and surgical exploration is sometimes required for diagnosis. Treatment is mainly surgical, but conservative medical treatment is also reported to be helpful. Apart from removal of bezoar, a dietary consultation is required to avoid eating habits leading to bezoar formation. Bariatric surgery is becoming more common; thus its complications are becoming more common as well. Majority of patients with bezoars have a prior history of gastric surgery. Therefore it is important to maintain a high level of suspicion for timely diagnosis of bezoars in patients with prior history of bariatric surgery, especially Roux-en-Y gastric bypass.

References

Pazouki A, Khalaj A, Tamannaie Z, Jangjoo A, Shapoori P, Kalhor M. Blood bezoar causing obstruction after laparoscopic Roux-en-Y gastric bypass. International journal of surgery case reports. 2014;5(4):183-5.

Ertugrul I, Tardu AT, Tolan K, Kayaalp C, Karagul S, Kirmizi S. Gastric bezoar after Roux-en-Y gastric bypass for morbid obesity: A case report. International journal of surgery case reports. 2016;23:112-5.

Ionescu AM, Rogers AM, Pauli EM, Shope TR. An unusual suspect: coconut bezoar after laparoscopic Roux-en-Y gastric bypass. Obesity surgery. 2008;18(6):756-8.

Ho TW, Koh DC. Small-bowel obstruction secondary to bezoar impaction: a diagnostic dilemma. World journal of surgery. 2007;31(5):1073-9.

Oh SH, Namgung H, Park MH, Park D-G. Bezoar-induced small bowel obstruction. Journal of the Korean Society of Coloproctology. 2012;28(2):89-93.

Razavianzadeh N, Foroutan B, Honarvar F, Forozeshfard M. Small bowel obstruction attributable to phytobezoar. Oxford medical case reports. 2016;2016(12):omw092.

Pinto D, Carrodeguas L, Soto F, Lascano C, Cho M, Szomstein S, et al. Gastric bezoar after laparoscopic Roux-en-Y gastric bypass. Obesity surgery. 2006;16(3):365-8.

Bedioui H, Daghfous A, Ayadi M, Noomen R, Chebbi F, Rebai W, et al. A report of 15 cases of small-bowel obstruction secondary to phytobezoars: predisposing factors and diagnostic difficulties. Gastroenterologie Clinique et biologique. 2008;32(6):596-600.

Ripollés T, García-Aguayo J, Martínez M-J, Gil P. Gastrointestinal bezoars: sonographic and CT characteristics. American Journal of Roentgenology. 2001;177(1):65-9.

Ladas S, Kamberoglou D, Karamanolis G, Vlachogiannakos J, Zouboulis‐Vafiadis I. Systematic review: Coca‐Cola can effectively dissolve gastric phytobezoars as a first‐line treatment. Alimentary pharmacology & therapeutics. 2013;37(2):169-73.

Sarhan M, Shyamali B, Fakulujo A, Ahmed L. Jejunal Bezoar causing obstruction after laparoscopic Roux-en-Y gastric bypass. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2010;14(4):592.

Published
2019-11-17
How to Cite
1.
Tavassoli A, Fakhlaei M, Abtahi Mehrjardi FS, Gazanchian M. A Bezoar Causing Bowel Obstruction After Roux-en-Y Gastric Bypass: A Case Report. Acta Med Iran. 57(6):395-397.
Section
Case Report(s)