Wake Forest Baptist Health Winston-Salem, NC, United States
Ted G. Xiao, MD, MS, Richard Evans, MD, Jared Rejeski, MD Wake Forest Baptist Health, Winston-Salem, NC
Introduction: Bezoars are most frequently encountered within the upper gastrointestinal tract and endoscopic therapy is established as a potential non-invasive intervention. Bezoars distal to the stomach are typically asymptomatic and able to pass without incident, making it a rare cause of small bowel obstruction (SBO); however, a prior intestinal surgery significantly increases the risk of bezoar-induced SBO. Endoscopic therapy for distal bezoar-induced obstruction is not well defined; this case discusses colonoscopic decompression for a bezoar-induced SBO.
Case Description/Methods: An 80-year-old female with a history of cor pulmonale and a prior right-hemicolectomy presented with progressive nausea, vomiting, dyspnea, and abdominal pain that worsened over a 24 hour period. On arrival, she was hypotensive, had dry oral mucosa, and diminished breath sounds bilaterally. Her abdomen was soft but diffusely tender with hypoactive bowel sounds. CT scan showed possible high-grade SBO versus large bowel obstruction near her ileocolic anastomosis. The patient initially improved with non-operative management, but bowel function did not return, which ultimately required endoscopic investigation. The colonoscopy was able to visualize friable mucosa and subtle luminal narrowing (~15mm) at the ileocolic anastomosis. A large obstructing bezoar was present at the neo-terminal ileum. Prolonged efforts to disimpact the bezoar fragmented the obstruction but failed to dislodge it. Following the colonoscopy, the patient had multiple bowel movements and tolerated oral intake. Post-procedural imaging showed an improving luminal gas pattern. With conservative management, her symptoms improved and she was discharged home.
Discussion: This case represents a patient with high surgical risk who developed a distal intestinal bezoar that was decompressed through colonoscopic intervention, thus avoiding operative management. Conventional treatment with surgical removal was not recommended in this case due to frailty, cardiovascular comorbidities, and respiratory compromise. To our knowledge, this is the first described colonoscopic decompression of a bezoar-induced SBO. An endoscopic approach to bezoar-induced SBO is less invasive and an intriguing option for a targeted population. We conclude that proper technique, bezoar composition, and shared decision-making are important factors contributing to success in endoscopic management of bezoar-induced SBO.
Disclosures: Ted Xiao indicated no relevant financial relationships. Richard Evans indicated no relevant financial relationships. Jared Rejeski indicated no relevant financial relationships.
Ted G. Xiao, MD, MS, Richard Evans, MD, Jared Rejeski, MD. P2535 - Colonoscopic Decompression of a Bezoar-Induced Small Bowel Obstruction, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.