Small Bowell Obstruction in a Post-Operative Patient : An Unlikely Plug with the Benefit of the Doubt

MEDICINE Research project

Small bowel obstruction (SBO) can be defined as the inability of the small intestine to propel its intraluminal contents. We present a case of small bowel obstruction in a post-operative patient, primarily presenting with upper gastrointestinal bleeding, followed by obstructive symptoms, managed initially as post-operative adhesions, but later revealed to be caused by an unlikely bezoar. A 70 year old male presented with a one-day history of bilious vomiting, followed by coffee-ground vomitus. Pertinent past medical history include a laparoscopic gastrojejunostomy, truncal vagotomy, and takedown of jejunostomy site of gastric outlet obstruction done five years prior to present condition. Initial impressive with history and physical examination was upper gastrointestinal bleeding probably secondary to post-operative complications. Gastroscopy demonstrated only ulceration but no active bleeding. Patient later manifested with progressive small bowel obstruciton, hence was referred to the authors. Diagnostic laparoscopy done revealed no adhesions; the obstruction was seen at the distal ileum due to a cylindrical foreign body. Histopathology showed degenerated tissues, further investigated to bea sausage or "longanisa". An uncommon diagnosis can occasionally be explained by the interaction of multiple common ones. The anatomical and physiological changes in the patient`s condition. Gastrointestinal bezoars are uncommon, lacks diagnostic features, and are often diagnosed intra-operatively.