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World J Gastrointest Surg. Aug 27, 2020; 12(8): 369-376
Published online Aug 27, 2020. doi: 10.4240/wjgs.v12.i8.369
Gastrointestinal obstruction secondary to enteral nutrition bezoar: A case report
Edward David Siddens, Yahya Al-Habbal, Mayank Bhandari
Edward David Siddens, Yahya Al-Habbal, Mayank Bhandari, General Surgery, Fiona Stanley Hospital, Upper Gastrointestinal Unit, Perth, Western Australia, WA 6150, Australia
Author contributions: Siddens ED, Al-Habbal Y, and Bhandari M contributed to the literature search, and drafting and revising of the paper.
Informed consent statement: Consent was obtained from the patient, both verbally and in written form, and has been attached to this submission.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Edward David Siddens, BM BCh, MBBS, Doctor, General Surgery, Fiona Stanley Hospital, Upper Gastrointestinal Unit, No. 223 Cape Street, Tuart Hill, 11 Robin Warren Drive, Perth 6150, Australia. siddense@tcd.ie
Received: May 7, 2020
Peer-review started: May 7, 2020
First decision: May 15, 2020
Revised: June 2, 2020
Accepted: August 4, 2020
Article in press: August 4, 2020
Published online: August 27, 2020
Processing time: 105 Days and 22.3 Hours
Abstract
BACKGROUND

Post-operative enteral nutrition via gastric or jejunal feeding tubes is a common and standard practice in managing the critically ill or post-surgical patient. It has its own set of complications, including obstruction, abscess formation, necrosis, and pancreatitis. We present here a case of small bowel obstruction caused by enteral nutrition bezoar. It is the second recorded incidence of this complication after pancreaticoduodenectomy in the medical literature.

CASE SUMMARY

The 70-year-old female presented to our institution for a pancreaticoduodenectomy (Whipple’s procedure) for pancreatic adenocarcinoma. On day 5 post-operative, having failed to progress and developing symptoms of small bowel obstruction, she underwent a computed tomography scan, which showed features of mechanical small bowel obstruction. Following this, she underwent an emergency laparotomy and small bowel decompression. The recovery was long and protracted but, ultimately, she was discharged home. A literature search of reports from 1966-2020 was conducted in the MEDLINE database. We identified eight articles describing a total of 14 cases of small bowel obstruction secondary to enteral feed bezoar. Of those 14 cases, all but 4 occurred after upper gastrointestinal surgery; all but 1 case required further surgical intervention for deteriorating clinical picture. The postulated causes for this include pH changes, a reduction in pancreatic enzymes and gastric motility, and the use of opioid medication.

CONCLUSION

Enteral feed bezoar is a complication of enteral feeding. Despite rare incidence, it can cause significant morbidity and potential mortality.

Keywords: Upper gastrointestinal surgery; Enteral nutrition; Gastrointestinal obstruction; Bezoar; Hepatobiliary; Case report

Core tip: Enteral feed bezoar is a complication of enteral feeding in the post-operative or critically ill patient. We present the second case in the literature of small bowel obstruction due to enteral nutrition solidification after pancreaticoduodenectomy. Although incidence is rare, it can have significant morbidity and potential mortality. Eight articles summarize 14 cases in the medical literature. Due to a combination of vague symptoms and vulnerable patient cohort, it can have extensive morbidity, with 13/14 cases requiring a second laparotomy. High clinical suspicion and low threshold for return to theatre is advised for these deteriorating patients.