Friend or foe: an unusual case of small intestinal mass.

Abstract

A previously healthy 72-year-old woman presented with a 2-year history of recurrent abdominal pain and bloating. The abdominal symptoms were often associated with food ingestion. No changes in defecation habits were noted. A local hospital diagnosed the patient with a mass in the small intestine and instructed regular follow-ups. The patient decided to seek further treatment at our facility and was scheduled for a small-intestine computed tomography (CT) scan with contrast. The CTscan showed a hyperdensemass in the proximal jejunum (▶Fig. 1 a), measuring 43×35mm, with neighboring intestinal dilation (▶Fig. 1b). No thickening or enhancement of the small-intestine wall was observed. Owing to the location of the mass, an antegrade double-balloon endoscopy (DBE) was performed for diagnosis. The scope was advanced to the horizontal part of the duodenum, near the ligament of Treitz, where a large duodenal diverticulum was noted (▶Fig. 2 a). The cavity was obstructed by a disk-shaped, yellow bezoar, with a size of approximately 30×40mm (▶Fig. 2b). A combination of endoscopic lithotripsy and lithotomy procedures were performed, and the bezoar was successfully removed (▶Fig. 3, ▶Video1). Bezoar is a foreign body that can be found anywhere in the gastrointestinal tract and is usually composed of animal or vegetable material [1]. The condition is more common in patients with predisposed conditions, such as poor gastric motility or previous gastric surgery. The most commonly used treatment for bezoar includes a combination of endoscopic lithotripsy with basket or fragmentation with polypectomy snares. Coca-Cola administration to dissolve the bezoar has also been proven to be a cheap and safe alternative [2]. However, due to the predisposed anatomical abnormality in this specific case, combined diverticulectomy may be necessary in the future.