Advanced Search

Home > Journals > Chirurgia > Past Issues > Chirurgia 2013 April;26(2) > Chirurgia 2013 April;26(2):129-31

ISSUES AND ARTICLES   MOST READ

CURRENT ISSUECHIRURGIA

A Journal on Surgery

Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index

Frequency: Bi-Monthly

ISSN 0394-9508

Online ISSN 1827-1782

 

Chirurgia 2013 April;26(2):129-31

    CASE REPORTS

A rare case of bowel perforation caused by a phytobezoar: case report

Scipioni F., Verre L., Mazzella A., Piccolomini A., Carli A. F.

Operative Unit of General Surgery 2, University of Siena Nuovo Policlinico Santa Maria alle Scotte, Siena, Italy

The authors describe a case of spontaneous ileal perforation in bowel obstruction caused by a phytobezoar. A young woman arrived at the Emergency Department with abdominal pain. The clinical story of the patient revealed a first neonatal surgery for meconium ileum, appendectomy and resection of a bleeding Meckel diverticulum. On admission, abdominal X-Ray and US were performed, showing distension of proximal bowel loops with gas and fluid levels and a thickened ileum loop with a conspicuous fluid level in peritoneal cavity. Due to the worsening of pain and with a suspicion of bowel perforation, the patient underwent urgent surgery. A complete obstruction of the last ileal loop by a phytobezoar was revealed. We proceeded, after enterotomy, to extract the vegetal concretion by milking the bowel. Ileal phytobezoars are an uncommon cause of obstruction and diagnosis is possible thanks to abdominal X-Ray, US, barium and CT. In our patient, the worsening of pain and the presence of endoabdominal fluid at the ultrasound imposed urgent surgical operation even without CT. The diagnosis of this unusual condition could be very difficult, indeed we decide for surgical approach even without a sure etiological diagnosis. Laparoscopy was not performed because of the previous multiple surgical accesses. This anomalous management resulted right and according to literature, in fact guidelines for this kind of patients provide an open surgical approach with enterotomy and milking of the bowel.

language: English


FULL TEXT  REPRINTS

top of page