CASE 68 Published on 11.10.2005

Intestinal obstruction caused by bezoar

Section

Abdominal imaging

Authors

Puech, M Vaudoux, P Douek

Patient

60 years, male

Clinical History
A 60- year-old man with acute abdominal pain.
Imaging Findings
A 60-year-old male patient presented with acute abdominal pain, associated with nausea and vomiting for 24 hours. His temperature was 37.2 C and he had a Leukocyte count of 8000. He did not undergo any prior surgery.
Discussion
There were multiple loops of dilated small bowel (>30 mm) which extended inferiorly. We observed a transition point consisting of a focal, ovoid, hypodense image located in the small bowel, just followed by normal small bowel loops. This implied the presence of an intestinal bezoar. Indeed, contrary to an intestinal obstruction on bridle formation, we could easily depict the transition point and assess its heterogeneous avascular density. We could also guess its intraluminal situation. This appearance is consistent with stercoral concretions in the small bowel, which can never be physiologic and should get the physician's attention. No vascular abnormality was detected. A bezoar is an amalgam of undigested vegetal fiber (i.e, cats make bezoars with their own peel!). Bezoars are conglomerates of food or fibers in the alimentary tract. This is a rare cause of intestinal obstruction, more frequently found among people who benefit from gastric surgery, and in children suffering from pica, psychiatric pathology, mental retardation, and trichotillomania.
Differential Diagnosis List
Intestinal obstruction caused by bezoar.
Case information
URL: https://www.eurorad.org/case/68
DOI: 10.1594/EURORAD/CASE.68
ISSN: 1563-4086