Successful treatment of small bowel phytobezoar using double balloon enterolithotripsy combined with sequential catharsis: A case report

Background: Small bowel bezoar obstruction (SBBO) is a rare clinical condition characterized by hard fecal masses in the small intestine, causing intestinal obstruction. It occurs more frequently in the elderly and bedridden patients, but can also affect those with specific gastrointestinal dysfunctions. Diagnosing SBBO is challenging due to its clinical presentation, which mimics other intestinal obstructions. While surgical intervention is the typical treatment for SBBO, advancements in endoscopic techniques have led to increased use of non-surgical methods, such as endoscopic lithotripsy.

Case summary: We report a case of small bowel obstruction induced by a phytobezoar. A 49-year-old male with a history of type 2 diabetes and long-term persimmon consumption presented to the hospital with symptoms of vomiting, abdominal distension, and constipation. Computed tomography revealed a small bowel obstruction with foreign bodies. Double balloon enteroscopy identified a phytobezoar blocking the intestinal lumen. The bezoar was successfully fragmented using a snare, and the fragments were treated with 100 mL of paraffin oil to facilitate their passage. This case report aims to enhance the understanding of this rare condition by detailing the clinical presentation, diagnostic process, and treatment outcomes of a patient with SBBO. Special attention is given to the application and effectiveness of non-surgical treatment methods, along with strategies to optimize patient management.

Conclusion: Double balloon enteroscopy combined with sequential laxative therapy is an effective approach for the treatment of a breakable phytobezoar.