Case Report
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World J Gastroenterol. Dec 28, 2014; 20(48): 18503-18506
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18503
''Sandwich'' treatment for diospyrobezoar intestinal obstruction: A case report
Yi-Xiong Zheng, Pankaj Prasoon, Yan Chen, Liang Hu, Li Chen
Yi-Xiong Zheng, Liang Hu, Li Chen, Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Pankaj Prasoon, Department of Hepato-Biliary-Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Yan Chen, Department of Gastrointestinal Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Author contributions: Zheng YX and Prasoon P contributed equally to the writing of this case report; Chen Y performed the endoscopical procedure; Hu L and Chen L collected and analyzed the data.
Supported by Projects of Administration of Traditional Chinese Medicine of Zhejiang Province, No. 2012ZA084
Correspondence to: Li Chen, MD, PhD, Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. chenli_hz@yahoo.com
Telephone: +86-571-87783570 Fax: +86-571-87022776
Received: April 7, 2014
Revised: June 8, 2014
Accepted: July 11, 2014
Published online: December 28, 2014
Processing time: 273 Days and 11.1 Hours
Abstract

Intestinal obstruction is a common clinical entity encountered in surgical practice. The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on the diagnosis and treatment. A 27-year-old male presented with a history of gastric pain combined with nausea and abdominal distension that had been present for 5 d. The presence of a foreign body was detected by computed tomography and observed as an abnormal density within the stomach. A diospyrobezoar was revealed during gastroscopy, the extraction of which was prevented due to its size and firmness. An endoscopic holmium laser joined with a snare was used to fragment the obstruction, which was followed by management with a conservative “sandwich” treatment strategy involving intestinal decompression with an ileus tube and Coca-Cola lavage between endoscopic lithotripsy fragmentation procedures. This strategy resulted in the successful removal of the diospyrobezoar along with multiple small bowel obstructions. The patient was discharged after abatement of symptoms. The case presented here demonstrates the implementation of a conservative, yet successful, treatment as an alternative to conventional surgical removal of intestinal obstructions.

Keywords: Small bowel obstruction; Diospyrobezoar; Ileus tube; Holmium laser; Endoscopy

Core tip: This case report presents the treatment of an intestinal obstruction using a conservative alternative to surgical therapy. A patient presented with signs of intestinal obstruction, which was confirmed by radiography. A diospyrobezoar was revealed during gastroscopy that was not extractable due to its size and firmness. The obstruction was successfully managed following holium laser fragmentation using a “sandwich” strategy of ileal tube decompression and Coca-Cola lavage between two endoscopic lithotripsy procedures. This treatment strategy should therefore be considered in place of surgical intervention for the treatment of intestinal obstructions.