An uncommon case of small bowel obstruction due to phytobezoar in a known case of tubercular abdomen: a decisional dilemma

Abstract

Study report the case of middle aged male who was presented with abdomen pain and diagnosed of small bowel obstruction caused by bezoar in a case of tubercular abdomen and review the literature. The initial presentation was generalised pain with nausea and vomiting and abdominal distension. Plain abdomen film showed diffuse dilated bowel loop in upper abdomen. Patient had similar recurrent episode 12 months back when he was managed conservatively and diagnosed as tubercular abdomen and he had taken ATT for 3 months. At this time patient managed conservatively, but did not respond. Later a CECT whole abdomen was done and patient diagnosed as cocoon abdomen with mass or a foreign body impacted at distal jejunal region with proximal bowel dilatation. Later patient revealed ingestion of a large mango seed 4 months back. Later patient was explored, adhesionolysis and enterotomy was done and phytobezoar was removed. Early history of recurrent tubercular obstruction with non- specific symptoms. Later recognition of condition by typical imaging and leading questions induced history image play an important role in to come to a diagnosis, with significant delay in diagnosis; and increase the morbidity and mortality.