Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2336-2340
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2336
Acute esophageal obstruction after ingestion of psyllium seed husk powder: A case report
Sujeong Shin, Jung Ho Kim, You Ho Mun, Han Sol Chung
Sujeong Shin, Jung Ho Kim, You Ho Mun, Han Sol Chung, Department of Emergency Medicine, Yeungnam University School of Medicine and College of Medicine, Daegu 42415, South Korea
Author contributions: Kim JH was the patient's emergency physician, reviewed the literature and performed review and editing; Shin S reviewed the literature and contributed to manuscript drafting; Mun YH and Chung HS reviewed the literature; Shin S and Kim JH were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by the 2021 Yeungnam University Research Grant.
Informed consent statement: We were unable to contact the patient. Written informed consent was not necessary because the patient data were not included in the manuscript.
Conflict-of-interest statement: The authors declare that there are no potential conflicts of interest relevant to this article.
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: Jung Ho Kim, MD, MM, Assistant Professor, Chief Doctor, Department of Emergency Medicine, Yeungnam University School of Medicine and College of Medicine, 170, Hyeonchung-ro, Daegu 42415, South Korea. jhkimem@yu.ac.kr
Received: October 8, 2021
Peer-review started: October 8, 2021
First decision: December 2, 2021
Revised: December 2, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: March 6, 2022
Processing time: 145 Days and 0.8 Hours
Abstract
BACKGROUND

Bezoar is a mass of hardened external material found in the gastrointestinal (GI) tract. It may form anywhere in the GI tract, but esophageal bezoar is rare because of the short esophageal transit time. Psyllium seed husk is an indigestible natural derivative that is widely used as an herbal laxative. Herein, we report a case of acute esophageal obstruction caused by a bezoar after ingestion of psyllium seed husk powder.

CASE SUMMARY

A 76-year-old male with Parkinson's disease visited the emergency department with swallowing difficulty approximately 10 h after ingesting psyllium seed husk powder. Symptoms began a few hours after ingestion and progressed to severe dysphagia. There were no abnormal findings on simple radiography. However, a computed tomography scan revealed an approximately 2.0 cm × 2.5 cm mass located near the gastro-esophageal junction. After grinding, the mass was removed using an endoscopic capture net. Esophageal bezoars may cause life-threatening complications. Patients with Parkinson's disease may have esophageal motility dysfunction, which may increase esophageal transit time. Since our patient had Parkinson's disease, this effect may have contributed to the formation of the bezoar.

CONCLUSION

Attention should be paid to using bulk-laxatives, and an appropriate specified regimen will be needed when marketed as a dietary supplement.

Keywords: Bezoar; Esophagus; Obstruction; Parkinson’s disease; Psyllium; Case report

Core Tip: In patients with functional esophageal disorders such as in those with Parkinson's disease, bulk-forming laxative regimens may increase the risk of esophageal bezoar formation. Furthermore, bulk-forming laxatives such as psyllium seed husk can be purchased cheaply over the counter in the form of herbal medications. Therefore, we recommend that physicians pay more attention to the use of bulk-forming laxative regimens in these patients. Furthermore, optimal usage guidelines and warning messages may need to be included when selling psyllium seed husk as a health supplement.