Mid-Jejunal Bezoar Causing Small Bowel Obstruction in an Adult With Intellectual Disability: A Case Report

Bezoar-induced small-bowel obstruction is an uncommon cause of mechanical intestinal obstruction that may be difficult to diagnose preoperatively because its presentation resembles more common obstructive conditions.We report a 47-year-old woman with intellectual disability and epilepsy who presented with persistent vomiting, poor oral intake, abdominal distension, and cessation of stool and flatus.Computed tomography demonstrated markedly dilated jejunal loops with intraluminal fecalization and a transition region, initially interpreted as likely adhesive obstruction.Exploratory laparotomy identified a transition point in the mid-jejunum, approximately 100 cm distal to the ligament of Treitz, caused by a firm, compact intraluminal mass measuring approximately 7 × 5 cm.The mass was removed through a transverse enterotomy without bowel resection because the bowel remained viable, without evidence of ischemia, necrosis, or perforation.The caregiver reported a habitual tendency to ingest non-food materials, providing a relevant clinical clue, although a formal diagnosis of pica was not established.The postoperative course was uncomplicated, with return of bowel function on postoperative day 2, oral feeding on day 3, and discharge after seven days.At two-week follow-up, the patient remained clinically well.Because the specimen was released to the family and was not subjected to histopathological or chemical analysis, its composition could not be confirmed.This case highlights the importance of caregiver-provided history and consideration of an intraluminal mass in unexplained small-bowel obstruction in patients with intellectual disability.