A Case of Obstruction and Perforation of the Ileum Resulting from a Spilled Bezoar

Takehiro Sakai, Nobuo Yagihashi, Tadaharu Osawa and Osamu Harada

Department of Surgery, Kuroishi City Hospital

A 77-year-old woman admitted for nausea in January 2005 was found in plain abdominal radiography to have multiple air-fluid levels. A nasogastric tube did not improve symptoms. A long intestinal tube inserted on hospital day 6 improved symptoms smoothly. Sudden abdominal pain onset was found in abdominal examination to involve peritoneal irritation on hospital day 10. Laboratory studies showed severe inflammation response. Intestinal radiography using a long intestinal tube showed an oval shadow in the small intestine. Abdominal computed tomography showed ascites, free air, and a sponge-like mass in the small intestine. Consumption of persimmons was confirmed in a detailed medical history interview. Surgery was conducted based on a diagnosis of small bowel obstruction and perforation due to spilled diosphyrobezoar impacted at the ileum about 30 cmfrom the ileocecal junction had perforated the ventral wall, necessitating ileal resection. A 4.2×2.6×2.8-cm black foreign body was suspected to be a spilled diosphyrobezoar. The postoperative course was uneventful and the patient was discharged on postoperative day 19. Although small bowel obstruction due to spilled bezoar is relatively rare, early diagnosis and treatment is important so that perforation can occur.

Key words
perforation, bezoar, ileus

Reprint requests
Takehiro Sakai Department of Surgery, Kuroishi City Hospital
1-70 Kitami-cho, Kuroishi, 036-0541 JAPAN

Accepted
June 22, 2005

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