Phytobezoar: A Cause of Intestinal Obstruction in Patients After Roux-en-Y Gastric Bypass
Juan Eduardo Flores-Martín, MD, Armando Pereyra-Talamantes, MSc, Humberto Salvador López-Téllez, MD
Department of Surgery, Hospital Central Militar, Mexico City, Mexico (Drs Flores-Martín, Pereyra-Talamantes, and López-Téllez).
Background: Intestinal obstruction is a common late complication of Roux-en-Y gastric bypass surgery, most commonly due to internal herniation or anastomotic strictures. Bezoars are a rare cause of obstruction in this setting, with very few cases reported in literature.
Case Report: The authors present the case of a 39-year-old female patient who underwent a laparoscopic Roux-en-Y gastric bypass for the treatment of severe obesity 9 years before her admission. Initially she weighed 140 kg, her body mass index was 50.8 kg/m2, and she didn’t have any known comorbid conditions. She was admitted to the emergency department at the hospital with abdominal pain, distention, nausea, and vomiting over 20 episodes that started 16 hours before her admission. After workup, a decision was made to perform a laparoscopic exploration. An 8-cm phytobezoar obstructing the common channel of the bypass was found; it was composed mostly of orange fibers and slices. It was extracted via enterotomy.
Results: In the postoperative period the obstructive syndrome was resolved, the patient was started on clear liquids in postoperative day 2 and sent home on postoperative day 5. The instructions were not to ingest large amounts of fiber and chewing on her meals. Her recovery was uneventful.
Conclusion: To the best of the authors’ knowledge there are about 15 reported cases of bezoar formation in patients who underwent Roux-en-Y gastric bypass surgery. As this procedure is more frequently performed worldwide, an increase on these types of cases is expected.
Key Words: Roux-en-Y gastric bypass; Intestinal obstruction; Bezoar; Phytobezoar.