Mooghal Mehwish, Ahmad Asrar, Safi Adnan, Khan Wajiha, Ahmad Naveed
Department of Surgery, Bahria University Medical and Dental College, Karachi, Pakistan.
Department of Surgery, PNS Shifa Hospital, Karachi, Pakistan.
J Med Case Rep. 2022 Mar 30;16(1):124. doi: 10.1186/s13256-022-03356-0.
Bezoars and polyps are an uncommon cause of mechanical intestinal obstruction. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Signs and symptoms classically vary from abdominal pain to constipation, nausea, vomiting, and abdominal distension. We present a rare case of impending perforation along with an intraluminal polyp near ileocecal junction due to phytobezoar impaction.
Our patient was a 59-year-old Sindhi female with a known history of interstitial lung disease and hypertension who presented to the emergency department with complaints of abdominal pain and constipation for 1 week, vomiting for 5 days, and abdominal distension for 2 days. After a preoperative examination and her failure to respond to conservative therapy, she was taken to the operating room for exploratory laparotomy. A hard intraluminal mass was suspected to be obstructing the small bowel at the site of impending perforation. This mass was a phytobezoar along with an intraluminal polyp. Resection of the affected segment was performed, followed by ileoileal anastomosis, and a drain was left. The patient was discharged 1 week later and was found to be well with no complaints at 3 weeks follow-up.
Early diagnosis of bezoars is important for early intervention and prevention of complications. Our case is unique as phytobezoar with intraluminal polyp is a rare clinical finding. Moreover, the signs and symptoms with which the patient presented are nonspecific and can be seen with multiple surgical emergencies.
胃石和息肉是机械性肠梗阻的罕见病因。胃石有四种不同类型：植物性胃石，由蔬菜和纤维构成；毛发性胃石，因摄入毛发所致，常与精神疾病有关；乳凝块性胃石，由乳凝块形成；药物性胃石，由药物引起。其体征和症状通常从腹痛到便秘、恶心、呕吐及腹胀不等。我们报告一例罕见病例，因植物性胃石嵌顿导致回盲部附近即将穿孔并伴有腔内息肉。
我们的患者是一名59岁的信德族女性，有间质性肺病和高血压病史，因腹痛、便秘1周，呕吐5天，腹胀2天就诊于急诊科。经过术前检查且保守治疗无效后，她被送往手术室进行剖腹探查。怀疑一个坚硬的腔内肿物在即将穿孔的部位阻塞了小肠。这个肿物是一个植物性胃石伴腔内息肉。切除受累肠段，随后进行回肠吻合，并留置引流管。患者1周后出院，3周随访时情况良好，无不适主诉。
胃石的早期诊断对于早期干预和预防并发症很重要。我们的病例很独特，因为植物性胃石伴腔内息肉是一种罕见的临床发现。此外，患者出现的体征和症状不具特异性，在多种外科急症中都可能出现。
