Small intestinal obstruction caused by the gastric bezoars in elderly diabetic patients: A case report

Introduction: Bezoar is an unusual cause of small bowel obstruction accounting for 0.4-4 % of all mechanical bowel obstruction. With the rising incidence of diabetes and the associated risk of gastrointestinal issues. Case presentation: A 59-year-old female diabetic patient with no prior surgical history presented with severe nausea, vomiting, and abdominal pain. CT scan revealed dilated small bowel loops, and endoscopy showed gastric retention with an impacted fecalith in the descending duodenum. At exploratory laparotomy, a bezoar was found impacted in jejunum 5-6 in. away from the Treitz ligament and was removed through an enterotomy. Clinical discussion: The discussion highlights the rarity of bezoar-induced small bowel obstruction and the diagnostic challenges it presents. Despite its low incidence, it is essential to consider phytobezoars in the differential diagnosis of small bowel obstruction, especially in middle-aged to older adult diabetic patients. The case underscores the importance of a detailed patient history and the use of imaging modalities such as computed tomography (CT) for accurate diagnosis. Early intervention is critical to prevent serious complications like bowel ischemia or perforation. When conservative treatments are ineffective, surgical intervention becomes necessary. Conclusion: Bezoar-induced small bowel obstruction remains an uncommon diagnosis. A detailed patient history and appropriate imaging are vital for timely diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in middle-aged to older adult diabetic patients or a history suggestive of increased fiber intake. CT scan is helpful for preoperative diagnosis. and highlights the need for increased awareness among clinicians regarding the management of bezoars.