Obstructive mobile small intestinal tumor without radiographic stigmata of bezoar

INTRODUCTION: Gastrointestinal leiomyomas are often clinically silent until they bleed or grow large enough to cause local mass effect. PRESENTATION OF CASE: We report the unique case of an otherwise healthy 69-year-old male who developed a small bowel obstruction secondary to a mobile small intestinal leiomyoma. During initial evaluation, computed tomography did not demonstrate the cause of obstruction. Because of worsening clinical status with conservative management, the patient required emergency laparotomy. Operative findings were significant for an intraluminal leiomyoma that had detached from its pedicle, traveled to the tight lumen of the distal ileum and acted as an obstructive “bezoar” composed of native tissue. Removal of the mass resulted in rapid metabolic stabilization and relief of symptoms. DISCUSSION: This case report illustrates the complexity of diagnosing obstruction secondary to intraluminal native tissue. Clinicians must be aware that such masses may clinically present as but not have corresponding radiographic stigmata of typical bezoars. CONCLUSION: In the absence of clear clinical or radiographic etiology for obstruction, developing a heightened degree of suspicion for native tissue “bezoar” may allow quick and appropriate management of similar cases and limit complications associated with prolonged obstruction. To our knowledge, this is the first reported case of mobile intraluminal leiomyoma causing small bowel obstruction.