Bezoar as a cause of jejunal afferent loop mass after pylorus preserving pancreaticoduodedectomy: A case report

INTRODUCTION AND IMPORTANCE: Bezoars may occur in patients after undergoing gastric surgery. Most bezoars are discovered due to small intestine obstruction, causing acute abdomen. CASE PRESENTATION: A 44-year-old woman with a history of intraductal papillary mucinous tumor of the pancreas was initially treated with pylorus-preserving pancreaticoduodenectomy. Two years ago, she had intermittent abdominal pain with no noted abnormality on computed tomography (CT) scan and gastroscopy. During her follow-up, an abdominal CT scan revealed a 1.8-cm low-enhancing nodular tumor with minute central calcification at the afferent loop of the jejunum, later diagnosed as a jejunal tumor. Endoscopy helped determine the location and characteristics of the tumor. Endoscopic findings revealed a bezoar approximately 3 cm below the pancreaticojejunostomy and hepaticojejunostomy, at the end of the afferent loop of the jejunum. Removal using an endoscopic basket failed as the bezoar broke halfway. Residual suture material was found inside the bezoar. Since the size of the bezoar decreased, the procedure was discontinued to allow it to dislodge naturally. CLINICAL DISCUSSION: Bezoars may be caused by gastric surgery, increased fiber diet, and psychiatric illness. As seen in this case, residual suture material caused bezoar formation. Bezoars mainly occur in the stomach and small intestines, but they can also occur in the afferent jejunal loop, as seen in this case. CONCLUSION: Surgeons should be careful not to leave behind suture material during gastric surgery. However, bezoar formation should be considered in patients complaining of abdominal pain even if they did not undergo gastrectomy.