A CLINICAL CASE REPORT: SMALL BOWEL OBSTRUCTION DUE TO PHARMACOBEZOAR

Tóm tắt

Small bowel obstruction (SBO) caused by aggregated medications is an extremely rare condition and can be easily overlooked due to its nonspecific clinical presentation. We report a case of a 65-year-old female patient admitted with fever and abdominal pain in the periumbilical and suprapubic region. The patient had a history of gastric ulcer and had been taking oral Maalox at a dose of two tablets per day for seven days prior to admission, swallowing the tablets whole without chewing. Laboratory tests revealed leukocytosis, an increased neutrophil count, and elevated C-reactive protein levels. Contrast-enhanced computed tomography of the abdomen demonstrated multiple disc-like, flat, high-density structures within the ileal lumen, associated with bowel wall thickening, mesenteric oedema, and mild dilatation of adjacent small bowel loops, suggesting pharmacobezoar-induced ileitis with early SBO. After failure of conservative treatment, the patient underwent surgery, which revealed multiple medication tablets impacted in the ileum, causing inflammation, oedema, luminal narrowing, and intestinal obstruction. Histopathological examination showed necrotising intestinal inflammation. This case highlights the important role of computed tomography in identifying rare causes of SBO and guiding timely management.