Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2020; 8(18): 4109-4113
Published online Sep 26, 2020. doi: 10.12998/wjcc.v8.i18.4109
Small bowel obstruction caused by a bezoar following an adult simultaneous liver-kidney transplantation: A case report
Gilbert Pan, Robin D Kim, Jeffrey Campsen, George Rofaiel
Gilbert Pan, Robin D Kim, Jeffrey Campsen, George Rofaiel, Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake, UT 84132, United States
Author contributions: Pan G participated in manuscript writing, data analysis, and proofreading/reviewing; Kim RD and Campsen J participated in patient care, data acquisition, and proofreading/reviewing; Rofaiel G participated in manuscript writing, patient care, data acquisition, data analysis, and proofreading/reviewing.
Informed consent statement: Informed consent was not required for this study. Case report analysis used anonymous data and unidentifiable images that were obtained after the patient agreed to treatment by written consent.
Conflict-of-interest statement: The author(s) have no conflict(s) of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: George Rofaiel, FACS, MD, Assistant Professor, Surgeon, Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, 30 N 1900 E, Salt Lake, UT 84132, United States. george.rofaiel@hsc.utah.edu
Received: May 7, 2020
Peer-review started: May 7, 2020
First decision: June 8, 2020
Revised: June 10, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: September 26, 2020
Abstract
BACKGROUND

Small bowel obstructions (SBOs) are common following a large intra-abdominal operation; however, SBOs caused by bezoars are unreported in patients following liver-kidney transplantation procedures, particularly in adults.

CASE SUMMARY

A 65-year-old Caucasian female presented with nausea and nonbilious emesis during her postoperative course following a simultaneous liver-kidney transplantation. She developed worsening nausea and vomiting with significant abdominal distension and obstipation. Computed tomography imaging showed a marked abnormal dilation of multiple small bowel loops with a distinct transition point that was suggestive of a small bowel obstruction. An exploratory laparotomy revealed a foreign body in the intestinal track approximately 30 cm from the ileocecal valve. The foreign body was extracted and identified as a bezoar with hair follicles and old digestive contents. Following the operation, the patient demonstrated rapid clinical improvement with resolution of nausea, emesis, and progress in bowel motility.

CONCLUSION

SBOs caused by bezoars can occur immediately following a liver-kidney transplantation and should not be discounted as a diagnosis.

Keywords: Case report, Liver transplantation, Liver-kidney transplantation, Small bowel obstruction, Post-transplant complications, Transplantation

Core Tip: Herein we present the management of an adult patient with a small bowel obstruction caused by a bezoar a week following a simultaneous liver-kidney transplantation. Radiographic imaging demonstrated an obstruction that required immediate surgical intervention. An exploratory laparotomy revealed a bezoar. Bezoars can occur immediately following a liver-kidney transplantation and should not be discounted as a diagnosis for a small bowel obstruction.