Background

Bezoar-induced small-bowel obstruction (SBO) after Roux-en-Y gastric bypass (RYGB) is uncommon and remains a diagnostic dilemma. Clinical Case: We present two cases of Bezoar-induced SBO. A 46-year-old female with lupus and RYGB presented with partial SBO. Abdominal CT showed a transition point distal to the jejunojejunal anastomosis (A). Diagnostic laparoscopy revealed a transition point in the distal ileum with intra-luminal food unable to be mechanically decompressed. An enterotomy, evacuation, and transverse closure were done. The postoperative course was unremarkable.A 39-year-old female with poor dentition and a remote history of RYGB, complicated by an internal hernia, presented with symptoms of SBO. Abdominal CT revealed ascites and multiple dilated small bowel loops (B). Diagnostic laparoscopy showed markedly dilated loops of bowel which was converted to open. A bulky intraluminal lesion representing a food bezoar was noted in the distal ileum. This was successfully decompressed into the colon. The postoperative course was unremarkable.

Conclusions

Bezoar-induced SBO after RYGB is an uncommon etiology. Bezoars can be asymptomatic or mimick symptoms of internal hernia or adhesive SBO post RYGB. Accurate diagnosis can be challenging and requires a high index of suspicion.Intestinal bezoars, specifically distal ileum, can be fragmented intraluminally by external compression and milked through the ileocecal valve. If unsuccessful, an enterotomy and extraction should be performed. We highlight the importance of maintaining a low threshold for diagnostic laparoscopy, ongoing nutritional counseling and recognize the impact of poor dentition in this patient population.