Gorgas Evan, Dowling Shawn
Department of Trauma, Acute, and Critical Care Surgery, Trinity Health Ann Arbor, 5305 Elliot Drive Suite 2B10 Ypsilanti, MI 48197, United States.
J Surg Case Rep. 2023 Oct 14;2023(10):rjad553. doi: 10.1093/jscr/rjad553. eCollection 2023 Oct.
Small Bowel Obstruction (SBO) is one of the most common diagnoses that general surgeons encounter. Adhesive disease, hernia, and neoplasm are the most common causes. A more rare cause is bezoar. A 66-year-old female with a history of prior abdominal surgery presented with clinical concern for SBO. CT scan of the abdomen and pelvis demonstrated SBO with a transition point in the left lower abdomen. The patient failed nonoperative management and was taken to the operating room for exploration. On exploration, a segment of hemorrhagic jejunum was found with an intraluminal bezoar. SBO secondary to bezoar can be managed endoscopically or operatively depending on location and size of the stone. Operative intervention can vary between laparoscopic milking of the bezoar distally, enterotomy with stone extraction, or bowel resection and anastomosis. This case illustrates the importance of maintaining a broad differential for common surgical disease processes.
小肠梗阻（SBO）是普通外科医生最常遇到的诊断之一。粘连性疾病、疝气和肿瘤是最常见的病因。一种较为罕见的病因是胃石。一名有腹部手术史的66岁女性因临床怀疑小肠梗阻就诊。腹部和盆腔CT扫描显示小肠梗阻，梗阻部位在左下腹。患者非手术治疗失败，被送往手术室进行探查。探查时，发现一段出血性空肠内有胃石。胃石继发的小肠梗阻可根据结石的位置和大小采用内镜或手术治疗。手术干预方式可包括腹腔镜下将胃石向远端挤出、切开肠壁取出结石或肠切除吻合术。本病例说明了对常见外科疾病过程保持广泛鉴别诊断的重要性。
