1148 A Rare Cause of Small Bowel Obstruction by a Phytobezoar at a Meckel’s Diverticulum: A Case Report

Abstract Introduction Small bowel obstruction (SBO) is a common surgical emergency, commonly caused by adhesions due to previous surgery or hernial obstruction. Rare causes include malignancy, inflammatory conditions, infections, congenital anomalies, and bezoars. Case presentation 54-year-old female presented with abdominal pain and distension, vomiting and constipation following ingestion of ripened jack fruit (Artocarpus heterophyllus). Her presentation and investigations were suggestive of SBO. Following exploratory laparotomy, a phytobezoar causing complete luminal obstruction at a broad-based Meckel’s diverticulum, two feet away from the ileocecal junction was identified. Diagnosis was confirmed by histopathology. Management included partial resection of the ileum incorporating the Meckel’s diverticulum with end-to-end anastomosis followed by an uneventful recovery. Discussion Bezoars are aggregates of swallowed, undigested material found within the gastrointestinal tract and if plant-based origin termed as “phytobezoars”. It is a rare occurrence in humans usually found within the stomach and small bowel commonly associated with an underlying cause for stasis. Bezoar is the cause of mechanical intestinal obstruction in 0.4-4% of all cases. Meckel’s diverticulum, the commonest congenital anomaly of the gastrointestinal tract, is the persistent vitelline duct from fetal life with a prevalence of 0.3% - 2.9%. localized deficiency of peristalsis and collection of undigested food in a Y shaped ‘pantaloon’ at a Meckel’s diverticulum may predispose to phytobezoars. Conclusions Phytobezoar obstruction at a Meckel’s diverticulum is a rare cause for SBO. Even with advanced imaging this can be overlooked and challenging to diagnose preoperatively. It is a rare but an important differential diagnosis that require a high degree of clinical suspicion.