Phytobezoar causing small bowel obstruction in a patient with Crohn's disease: A case report

INTRODUCTION AND IMPORTANCE: Bezoars form in any location in the gastrointestinal tract with the small bowel being uncommon. The presentation with a small bowel obstruction (SBO) is rare, representing less than 1 % of cases. Phytobezoar causing a SBO in the setting of Crohn's disease is exceedingly rare with only three cases reported in the literature. CASE PRESENTATION: This case details the presentation and operative management of a phytobezoar causing small bowel obstruction in a patient with Crohn's disease. The patient is a 69-year-old male presenting with nausea, emesis, and obstipation. Imaging performed indicated a SBO with an obstructing intraluminal foreign body. The patient required exploration and a large phytobezoar was identified at the point of obstruction. This was treated with a segmental resection. The postoperative course was complicated by an anastomotic leak with re-exploration and end ileostomy. CLINICAL DISCUSSION: Phytobezoars are formed from indigestible plant residue which can accumulate and form a foreign body causing an obstruction in the small bowel. This is a rare occurrence in the setting of Crohn's disease. Most of these cases are managed surgically with a strictureplasty and enterotomy or a small bowel resection. CONCLUSION: Phytobezoars in the setting of Crohn's disease is very unusual. The pathophysiology of the disease predisposes patients to strictures and the mass-like foreign body can cause a bowel obstruction. This is typically managed surgically with a strictureplasty and enterotomy or in our case with an enterectomy.