Clinical Report: Atypical Etiology of Small Bowel Obstruction in a Liver Transplant Patient

Overview

This report presents a case of phytobezoar-induced small bowel obstruction (SBO) in a liver transplant recipient, highlighting the atypical causes of SBO in this population. The use of intraoperative indocyanine green (ICG) fluorescence for bowel viability assessment is emphasized as a novel approach.

Background

Incorporate statistics on SBO prevalence in transplant patients and the role of bezoars.

Data Highlights

No numerical data or trial data was presented in the article.

Key Findings

• A 60-year-old male liver transplant recipient developed SBO due to a phytobezoar after consuming wild mushrooms.
• Initial imaging suggested adhesional SBO, but surgical exploration revealed an intraluminal mass.
• Intraoperative ICG fluorescence confirmed bowel viability, avoiding unnecessary resection.
• Literature review identified 5 out of 7 SBO cases in transplant patients attributed to bezoars, primarily at Roux-en-Y anastomoses.
• Individualized dietary counseling is recommended for transplant recipients to prevent bezoar formation.

Clinical Implications

Clinicians should maintain a low threshold for surgical exploration in transplant recipients with SBO, especially when conservative management fails. The incorporation of ICG fluorescence during surgery may enhance decision-making regarding bowel viability and reduce the need for resection.

Conclusion

Bezoars represent a rare but critical cause of SBO in liver transplant recipients, underscoring the need for heightened awareness and tailored dietary strategies in this population.

Related Resources & Content

1. Successful Management of Extensive Mesenteric Infarction via Midgut Resection and Duodenocolostomy: A Case Study, 2015
2. Investigating Gut Barrier Dysfunction's Impact on Postoperative Outcomes Following Liver Transplantation: Insights into Pathophysiology and Treatment Options, 2024
3. Liver Transplantation from a Donor with Total Situs Inversus: A Unique Challenge, 2024
4. Techniques in Coloproctology — Identifying Patient-Specific Risk Factors for Outlet Obstruction in Diverting Loop Ileostomy After Minimally Invasive Surgery for Rectal Cancer
5. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update
6. Evaluating Hyperosmolar Water-Soluble Contrast Media for Diagnosing Adhesive Small Bowel Obstruction
7. Preview
8. Radiomic Analysis Based on Abdominal CT-Scan to Predict Strangulation in Adhesive Small Bowel Obstruction: Preliminary Results - PMC
9. Bowel obstruction following liver transplantation: clinical and ct findings in 48 cases with emphasis on internal hernia - PubMed
10. Bowel Obstruction From Biliary Stent Migration: An Unusual Case of Abdominal Pain - PubMed
11. Small bowel obstruction due to Roux-en-Y enterolith 13 years following deceased donor liver transplantation: a case report | Journal of Surgical Case Reports | Oxford Academic
12. Frontiers | Unusual Cause of Small Bowel Obstruction in a Liver Transplant Recipient: A Case Report and Focused Literature Review
13. Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography - PMC
14. Successful treatment of small bowel phytobezoar using double balloon enterolithotripsy combined with sequential catharsis: A case report - PubMed
15. Perioperative Considerations in Older Kidney and Liver Transplant Recipients: A Review - PMC