Multiple small bowel obstructions due to unusual formation of biliary phytobezoars following laparoscopic cholecystectomy in a sickler patient: A case report, an atypical surgical approach.

INTRODUCTION & IMPORTANCE: Bezoar formation in gastrointestinal tract is relatively a rare condition. A phytobezoar is the most common type of bezoar (Kement et al., 2012 [6]). Biliary phytobezoar is an extremely rare condition and is usually reported in patients had previous biliary procedures or in presence of bilioenteric fistula (Albogami et al., 2018; Kement et al., 2012; Kim et al., 2006 [2, 6, 7]).

CASE PRESENTATION

35-year-old female with sickle cell anemia (SCA). On 2003 she had gallstones (GS) and obstructive jaundice. She was treated at that time by endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy with stent insertion, followed by laparoscopic cholecystectomy (LC). Two years afterwards she had open appendectomy for acute appendicitis. Six months afterward, she suffered several episodes of small bowel obstructions (SBO) for several years. Later, it was discovered due to unusual formation of primary gallstones and subsequent development of biliary phytobezoars accumulated in the terminal ileum causing SBO.

CLINICAL DISCUSSION

We are presenting an extremely rare case who developed biliary phytobezoars formation in the absence of a bilioenteric fistula leading to multiple small bowel obstructions. The origin of the gallstones was primary type. The surgical approach was limited right hemicolectomy solved her problem completely until the date of this publication.

CONCLUSION

The nature of the disease adding higher risk of morbidity. Management of sicklers with surgical conditions should be individualized. Sicklers with asymptomatic gallstones should have early LC before complications begin. Because anticipated complications carry significant morbidity. The advances in surgical technology and better awareness of the pathophysiology provided an improved and better outcome.