A Small Bowel Obstruction Secondary to Jejunal Bezoar

TL;DR

An 82-year-old woman had a bowel blockage caused by a rare calcified mass in her small intestine, which was surgically removed.

Contribution

This case report presents a rare instance of jejunal bezoar causing small bowel obstruction in an elderly patient.

Findings

A calcified bezoar was identified as the cause of small bowel obstruction in the proximal jejunum.

The bezoar was successfully removed via enterotomy during surgery.

Jejunal diverticula were likely contributors to bezoar formation in this patient.

Abstract

An 82-year-old woman presented with a two-day history of bilious vomiting, abdominal bloating, and epigastric discomfort. She remained hemodynamically stable without signs of peritonitis. Abdominal CT revealed small bowel obstruction with a transition point in the proximal jejunum, caused by a heterogeneous mass with curvilinear calcification, suspicious for a bezoar. Given its size, location, and the low likelihood of spontaneous passage, surgical intervention was undertaken. Laparotomy confirmed a 6×6 cm calcified bezoar located 70 cm distal to the duodenojejunal flexure, with multiple proximal jejunal and duodenal diverticula likely contributing to its formation. The bezoar was removed via enterotomy without complications. This case highlights an uncommon cause of small bowel obstruction and the importance of considering bezoars in elderly patients with underlying diverticular disease.

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