Phytobezoar-Induced Small-Bowel Obstruction Successfully Diagnosed and Treated by Single-Balloon Enteroscopy

Single-operator single-balloon enteroscopy is safe and effective: A 6-year retrospective study

OBJECTIVES

Single-balloon enteroscopy (SBE) is an effective tool for the detection of small intestine lesions. Because it is conventionally performed by two operators, the efficacy of single-operator SBE method has not yet been elucidated. We aimed to evaluate the diagnostic yield, total enteroscopy rate, procedure time, and complications of single-operator SBE for small intestinal disease.

METHODS

This was a single-center, retrospective study including consecutive patients who underwent single-operator SBE for suspicious small intestinal disorders or required therapeutic interventions between December 2014 and January 2019. The SBE procedures were performed by four endoscopists. Diagnostic yield, total enteroscopy rate, procedure time, incubation depth, and complications were analyzed, and stratification analysis was performed.

RESULTS

Altogether 922 patients with 1422 SBE procedures were included for analysis, among whom 250, 172, and 500 patients underwent SBE via the oral route, the anal route and a combined route, respectively. The overall diagnostic yield was 78.52% (724/922). And 253 patients achieved total enteroscopy, with a total enteroscopy rate of 56.10%. The average procedure time for the oral and anal routes were 69.28 ± 14.72 min and 64.95 ± 13.87 min, respectively. While the incubation depth was 389.95 ± 131.42 cm and 191.81 ± 83.67 cm, respectively. Jejunal perforation was observed in one patient, which was managed by endoclips. Stratification analysis showed that the diagnostic yield and total enteroscopy rate significantly increased with operation experience together with decreased procedure time.

CONCLUSION

Single-operator SBE is effective and safe for the detection of small intestinal lesions, and is easy to master.

Application of balloon-assisted enteroscopy in treatment of small intestinal diseases

This review focuses on the application of balloon-assisted enteroscopy in the treatment of small bowel diseases which mainly include small bowel bleeding, benign small bowel stenosis, benign small bowel tumors, malignant small bowel obstruction, and foreign body retention in the small intestine. The operations involved in the treatments for those diseases include enteroscopic sclerotherapy injection, argon plasma coagulation, and endoscopic clip ligation; endoscopic balloon dilation and endoscopic stricturotomy; endoscopic mucosal resection, endoscopic submucosal dissection, and endoscopic full-thickness resection; and self-expanding metal stent placement and small intestinal foreign body retrieval, respectively.

A Rare Cause of Small Bowel Obstruction: A Case Report

Introduction

Small bowel obstruction is a common surgical emergency abdominal condition in clinical practice. Fecalith is one of the rare causative factors, especially phytobezoars.

Case Report

We report the case of a 66-year-old man admitted with “abdominal pain with vomiting for 1 day.” Enhanced CT of the abdomen suggested incomplete small bowel obstruction. The symptomatic treatment with fasting, fluid replacement, gastrointestinal decompression, and antibiotics was conducted after the patient was admitted to the hospital. After 2 days of treatment, the patient's abdominal pain was not significantly relieved, so a decision was made to perform laparoscopic examination surgery. During surgery, a columnar foreign body was found embedded in the lumen of the small intestine about 10 cm away from the ileocecal region. Combined with the patient's preoperative history of consuming a large number of persimmons, the primary diagnosis of small intestinal fecalith obstruction was considered. We performed an enterotomy to remove the foreign body, and the procedure was uneventful. On postoperative day 7, the patient was successfully discharged.

Conclusion

When we encounter a patient with intestinal obstruction without a history of surgery in our clinical work, we should take a careful history, especially about the consumption of foods that can cause phytoliths. When a patient has consumed a large amount of food that can cause phytobezoars before the abdominal pain, we should diagnostically consider it as phytobezoars intestinal obstruction, which helps to reduce the incidence of misdiagnosis and allows the patient to receive treatment timely and effectively.