title: Small bowel obstruction caused by dried apple.
abstract: BACKGROUND
  Small bowel obstruction in a virgin abdomen is an uncommon surgical condition. While malignancy, inflammatory bowel disease and foreign body are the main reported causes, undigested food bezoar causing bowel obstruction is a rare entity. We report a case of small bowel obstruction secondary to dried preserved apple having re-expanded within the gastrointestinal tract.
  
  
  METHODS
  A 69 year old male presented with severe abdominal distension, generalized abdominal tenderness and obstipation for 1 week. Small bowel obstruction (SBO) was confirmed on plain abdominal X-ray and CT imaging. An emergency explorative laparatomy identified a sausage-shaped intra-luminal foreign body obstructing the distal ileum. An enterotomy was performed which revealed a rehydrated, donut-shaped piece of dried apple.
  
  
  CONCLUSIONS
  Swallowed items that pass through the pylorus rarely cause obstruction as they are usually small enough to pass through the rest of the bowel without difficulty. We postulate that in our patient that the dried apple was originally small enough to pass through the pylorus. However during small bowel, its' highly absorbable nature resulted in an increase in size that prevented its' passage through the ileocecal valve. A simple in-vitro experiment discovered that dried apple has a potential to reabsorb fluid and expand up to 35% of its initial size within 72h.
  
  
  CONCLUSIONS
  This report illustrates the potential for dried food substances to cause intra-luminal SBO after significant expansion with rehydration.
authors.affiliation: Campbelltown Public Hospital, Sydney South West Local Health District, Therry Rd., Campbelltown, New South Wales 2560, Australia. Electronic address: smso562@uowmail.edu.au.
authors.forename: Sally
authors.initials: S
authors.lastname: Ooi
authors.affiliation: Campbelltown Public Hospital, Sydney South West Local Health District, Therry Rd., Campbelltown, New South Wales 2560, Australia. Electronic address: khiemhong.dr@gmail.com.
authors.forename: Khiem
authors.initials: K
authors.lastname: Hong
keywords: Bezoar; Dried apple; Small bowel obstruction; Virgin abdomen
references.citation: Ulus Travma Acil Cerrahi Derg. 2011 May;17(3):286-8
references.pmid: 21935813
references.citation: Isr Med Assoc J. 2014 Apr;16(4):255-6
references.pmid: 24834765
references.citation: ScientificWorldJournal. 2013 Apr 18;2013:298392
references.pmid: 23690741
references.citation: Trop Doct. 2011 Apr;41(2):85-90
references.pmid: 21421885
references.citation: Ulus Travma Acil Cerrahi Derg. 2010 Jul;16(4):376-8
references.pmid: 20849060
references.citation: BMJ Case Rep. 2010 Nov 12;2010:null
references.pmid: 22798446
references.citation: BMC Surg. 2003 Sep 04;3:5
references.pmid: 12956890
references.citation: BMJ Case Rep. 2011 May 19;2011:null
references.pmid: 22696764
references.citation: Pediatrics. 2012 Oct;130(4):e1011-4
references.pmid: 22987870