Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Nov 28, 2024; 16(11): 683-688
Published online Nov 28, 2024. doi: 10.4329/wjr.v16.i11.683
Successful treatment of small bowel phytobezoar using double balloon enterolithotripsy combined with sequential catharsis: A case report
Bing-Yun Lu, Zhi-Yu Zeng, Dong-Jing Zhang
Bing-Yun Lu, Zhi-Yu Zeng, Dong-Jing Zhang, Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518100, Guangdong Province, China
Author contributions: Zeng ZY was responsible for ensuring that the descriptions were accurate and were agreed upon by all authors and patients, he also collected the data for the study; Lu BY wrote the manuscript and corrected the manuscript for its scientific basis; Zhang DJ revised the manuscript for grammar and syntax mistakes; All authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
Conflict-of-interest statement: The authors have no conflict 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Yu Zeng, MD, Doctor, Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, No. 1333 Xinhu Road, Baoan District, Shenzhen 518100, Guangdong Province, China. zengzhiyu_smu@163.com
Received: June 30, 2024
Revised: September 26, 2024
Accepted: October 25, 2024
Published online: November 28, 2024
Processing time: 149 Days and 17.6 Hours
Abstract
BACKGROUND

Small bowel bezoar obstruction (SBBO) is a rare clinical condition characterized by hard fecal masses in the small intestine, causing intestinal obstruction. It occurs more frequently in the elderly and bedridden patients, but can also affect those with specific gastrointestinal dysfunctions. Diagnosing SBBO is challenging due to its clinical presentation, which mimics other intestinal obstructions. While surgical intervention is the typical treatment for SBBO, advancements in endoscopic techniques have led to increased use of non-surgical methods, such as endoscopic lithotripsy.

CASE SUMMARY

We report a case of small bowel obstruction induced by a phytobezoar. A 49-year-old male with a history of type 2 diabetes and long-term persimmon consumption presented to the hospital with symptoms of vomiting, abdominal distension, and constipation. Computed tomography revealed a small bowel obstruction with foreign bodies. Double balloon enteroscopy identified a phytobezoar blocking the intestinal lumen. The bezoar was successfully fragmented using a snare, and the fragments were treated with 100 mL of paraffin oil to facilitate their passage. This case report aims to enhance the understanding of this rare condition by detailing the clinical presentation, diagnostic process, and treatment outcomes of a patient with SBBO. Special attention is given to the application and effectiveness of non-surgical treatment methods, along with strategies to optimize patient management.

CONCLUSION

Double balloon enteroscopy combined with sequential laxative therapy is an effective approach for the treatment of a breakable phytobezoar.

Keywords: Intestinal obstruction; Double balloon enteroscopy; Phytobezoar; Paraffin oil; Laxatives; Case report

Core Tip: This case shows the successful treatment of a small intestinal phytobezoar using double balloon enteroscopy combined with sequential catharsis. Paraffin oil effectively prevents secondary obstruction caused by the accumulation of fragments in the intestine. Sequential catharsis may aid in the expulsion of the bezoar and help prevent recurrence. It is essential for the physician to ensure that the bezoar is completely expelled, as this represents the optimal end point of the treatment.