Bizarre behaviour, bizarre intruder and bizarre bowel obstruction.
An 82-year-old woman, with previous history of hiatal hernia, cholecystectomy and depression, has been admitted for worsening diffuse abdominal pain with constipation and vomiting for 4 days. She lived alone, without signs of dementia or cognitive impairment. The abdomen was distended and tender in middle quadrants. Abdominal x-ray revealed concentric distension of bowel loops. CT scan confirmed mechanical small bowel obstruction with a transition point in the right iliac fossa. At laparotomy, the obstruction was caused by an intraluminal mass. After enterotomy, a 5.5 cm large phytobezoar was extracted; immediately after, a small live insect jumped out from the vegetable mass crawling onto the surgical area. The specimen was sent for parasitology and identified as a crustacean isopod, terrestrial arthropod, classified in the phylum Arthropoda, subphylum Crustacea and order Isopoda. They usually live in humid, moist conditions, obtaining their nourishment from decomposing vegetable matter. They often colonise in greenhouse pot plants. No cases of parasitisation in vertebrate species have been reported to date.
Emergency and Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna, Italy. salo75@inwind.it
Salomone
S
Di Saverio
Fausto
F
Catena
Federico
F
Coccolini
Filippo
F
Gazzotti
Filippo
F
Filicori
Luca
L
Ansaloni
D000369:Aged, 80 and over; D000818:Animals; D001630:Bezoars / Q000150:complications / Q000175:diagnosis / Q000469:parasitology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000469:parasitology* / Q000601:surgery; D033321:Isopoda