Afferent loop obstruction induced by undigested food (phytobezoar) treated through endoscopic fragmentation with biopsy forceps: A case report

INTRODUCTION AND IMPORTANCE: Afferent loop obstruction (ALO) can occur as a complication of gastrectomy with Billroth II or Roux-en-Y reconstruction. Conventionally, emergent surgery was performed for most cases, while endoscopic procedures for elective cases have been reported more recently. We report a unique case of ALO caused by a phytobezoar that was successfully treated by endoscopic procedures. CASE PRESENTATION: A 76-year-old female patient presented with epigastric pain for several hours after dinner. The patient had a history of distal gastrectomy with Roux-Y reconstruction for gastric cancer at age 62. Computed tomography (CT) demonstrated evident dilation of the duodenum and common bile duct, and detected a bezoar at the jejunojujunal anastomosis site, indicating that the ALO was induced by the bezoar. Upper endoscopy visualized undigested food formation stuck at the anastomosis site, and it was successfully dislodged by endoscopic fragmentation using biopsy forceps. After the procedure, the abdominal symptoms subsided, and the patient was discharged on the fourth day. CLINICAL DISCUSSION: Bezoar-induced ALO is rare. In this case, CT helped diagnose the ALO induced by the bezoar. In recent times, there has been a rise in endoscopic interventions for ALO, and there are some reports of bezoar-induced small bowel obstruction being treated endoscopically. Therefore, a subsequent endoscopic examination was performed, confirming the presence of a phytobezoar and leading to a less invasive endoscopic fragmentation treatment in this case. CONCLUSION: This is a unique case report of phytobezoar-induced ALO treated by endoscopic fragmentation of undigested food, providing a beneficial treatment option.