67 years old man with abdominal distention and nausea vomiting

 

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Doctor's Information

Name : Kaveh
Family : Samimi
Affiliation :Radiology Department,Hazrat Rasule Akram Hospital,TUMS
Academic Degree : Assistant Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Maryam Soleimanpur

 

Case Section

Abdominal Imaging

 

Patient's Information

Gender : Male
Age : 67

 

Clinical Summary

67 years old man with abdominal distention and nausea vomiting

 

Imaging Findings

CT scan shows an ovoid mass containing mottled gas at the jejunum along with diffuse small intestinal dilatation due to obstruction.

 

Differential Diagnosis

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Final Diagnosis

Bezvoar

 

Discussion (Related Text)

A phytobezoar is a concretion of poorly digested fibers, fruit seeds, and pulpy fruits, especially oranges and persimmons, causing small intestinal obstruction usually after migration of a gastric phytobezoar. However, the obstruction is also caused by a primary bezoar (an enterolith) formed in the small intestine in association with underlying small bowel diseases such as diverticula, strictures, or tumors.239 Gastric surgery is the most predisposing factor for the development of phytobezoar; other factors include poor mastication, autonomic neuropathy, and overconsumption of foods with a high fiber content.316 Early diagnosis is important because phytobezoars provoke decubitus ulcer, pressure necrosis, perforation, and even strangulation if the diagnosis is delayed.The most common cr findings of phytobezoars include a round or ovoid or a long sausage-shaped mass containing mottled gas at the obstructed site Phytobezoars are rarely manifested as a soft tissue mass without gas, resembling an intraluminal tumor or intussusception. In these cases, barium study may give the clue in suggesting the diagnosis, and the diagnosis should be suspected when intraluminal filling defects appear to be mobile or multiple.

 

References

Haaga J: CT and MR imaging of the whole body, 5th ed. Philadelphia: Mosby, 2009.

 

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