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Case Reports in Surgery
Volume 2017, Article ID 2702896, 3 pages
https://doi.org/10.1155/2017/2702896
Case Report

Small Bowel Obstruction Secondary to a Metamucil Bezoar: Case Report and Review of the Literature

Department of Surgery, American University of Beirut Medical Center, Cairo Street, Riad El Solh, P.O. Box 11-0236, Beirut 1107 2020, Lebanon

Correspondence should be addressed to Ali Hallal; bl.ude.bua@50ha

Received 4 April 2017; Accepted 17 August 2017; Published 20 September 2017

Academic Editor: Claudio Feo

Copyright © 2017 Sara Abou Azar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bezoar-induced small bowel obstruction is a rare entity. It should be highly suspected in patients with gastric hypomotility disorders, psychiatric conditions, prior abdominal or bariatric surgery, or improper intake of medication. Their diagnosis is quite challenging and surgical exploration remains the best treatment of choice to ensure the viability of the small bowel tissue and relieve the obstruction. This is a case of a 48-year-old female with no previous abdominal surgery who presented with acute abdominal pain. The patient’s history was remarkable for the daily ingestion of 1.5 teaspoons of Metamucil with minimal amount of water. Computed tomography scan demonstrated dilated small bowel loops and a transition zone at the level of the mid jejunum. On laparoscopy, the patient was found to have a hard mass in the mid jejunum amenable to gentle fragmentation and breakdown. Metamucil bezoars are due to the solidification of psyllium-based substances in the gastrointestinal tract. The usual management of small bowel obstruction induced by a bezoar is exploratory laparotomy with enterotomy and primary anastomosis. Laparoscopic intervention has gained popularity among surgeons with good outcome and lower morbidity. In this unusual case, the small bowel obstruction induced by the Metamucil bezoar was safely treated with laparoscopic fragmentation alone.