Radiology Teaching Files > Case 278496

Contributed by: david alexander, Resident, Virginia Mason Medical Center, Washington, USA.
Patient: 45 year old
History: Bowel obstruction

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Findings: Bezoar within diverticula in the jejunum and duodenum. Note no inflammatory changes to suggest an abscess.

Bezoars within diverticula.
Partial SBO.

Whether there are diverticula present in the small bowel depends on what criteria, if any, one uses to diagnose diverticula, and whether there are bezoars in these supposed diverticula depends on how one defines bezoars. Some define bezoars in terms of tough hardy things that are difficult to get out, whereas others use the word in a much looser sense. There is even a case near by where the examiner speaks of a lacto-bezoar in a stomach obstructed by hypertrophic pyloric stenosis. In any event there are some good articles in the main-steam literature describing the small bowel feces sign in prolonged partial small bowel obstruction and I think this is what your case represents. The bubbly stuff represents probably just undigested food with air bubbles trapped within. The retained food etc is the result and not the cause of the obstruction in other words. The general surgeons have been aware of this phenomenon for a long time. I was a surgical resident long before there was CT and I recall the ominous feeling that came over the surgical team when a NG tube would return foul brown material or if the patient vomited similar material. Guess what we called it. Thatís right. Fecal vomiting and it indicated that obstruction had been present for a while and it gave special impetus to our surgical attack on the problem, after appropriate re-hydration. --STEVE DOAK, 2004-12-31
Additional Details:

Case Number: 278496Last Updated: 12-31-2003
Anatomy: Gastrointestinal (GI)   Pathology: Congenital
Modality: CTExam Date: Access Level: Readable by all users
Keywords: bezoar, diverticulum

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