title: An unusual case of biliary bezoar causing small bowel obstruction in a patient with ampullary diverticulum and stapled gastroplasty.
abstract: Primary small bowel bezoars constitute 0.44% of small bowel obstructions (SBO). We report a case of a man with a history of gastroplasty who presented with lower abdominal pain. Initial examination revealed leucocytosis and serum lipase. CT of the abdomen/pelvis was consistent with pancreatitis, cholelithiasis and a stable, 3.8 cm, ampullary diverticulum, without obstruction of the pancreatic/common bile duct. Considering this was the patient's first episode of pancreatitis with evidence of cholelithiasis, it seemed prudent that he would benefit from cholecystectomy but not diverticulectomy. Post-cholecystectomy he represented to the hospital with biliary emesis. CT of the abdomen/pelvis revealed postsurgical changes. Owing to non-resolution of the symptoms, 48 h later a small bowel follow-through was obtained that suggested partial SBO. Ultimately, the patient was taken for exploratory laparoscopy and small bowel resection, after a large intramural mass was encountered in the small bowel. Final pathology revealed a 3 cm biliary bezoar causing obstruction and stercoral ulceration.
authors.affiliation: Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: Awais
authors.initials: A
authors.lastname: Ashfaq
authors.affiliation: Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Madura
authors.affiliation: Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Chapital
mesh_terms: D001630:Bezoars / Q000150:complications / Q000175:diagnosis*; D002763:Cholecystectomy / Q000009:adverse effects*; D002769:Cholelithiasis / Q000601:surgery; D002779:Cholestasis / Q000601:surgery; D003135:Common Bile Duct / Q000473:pathology*; D004240:Diverticulum / Q000150:complications*; D005548:Foreign-Body Migration; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000209:etiology; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000601:surgery