Intestinal intussusception is a rare cause of bowel obstruction in the adult, and no such one produced by a bezoar has been described in the medical literature.

A 49-year-old man with an unremarkable past medical history came to the Emergency Department complaining of abdominal pain in the epigastrium of 3-4 day progression, associated with a reduced number and quantity of daily bowel movements. Physical examination was consistent with bowel obstruction. A plain abdominal film revealed segment dilation up to the jejunum (Figs. 1 and 2). An abdominal computed axial tomography (CAT) scan identified an oval-shaped lesion that appeared to be an intestinal invagination in the right flank (Figs. 3 and 4). Given the diagnosis of bowel obstruction, emergency surgery was performed. Mechanical ileus of the small bowel in the mid jejunum due to invagination was observed, along with an intestinal bezoar that measured 6 x 4 x 3cm with 2 invaginated zones and ulcerated serous membrane. About 40cm of the small bowel was resected and an end-to-end anastomosis was performed (Figs. 5 and 6). Postoperative progression was satisfactory.

Figures 1 and 2.

Plain x-ray images showing small bowel obstruction data.

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Figures 3 and 4.

Computed axial tomography images in which the segment involved in the intussusception can be seen.

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Figure 5.

Image of the surgical specimen showing the ischemia produced by the bezoar.

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Figure 6.

The sectioned bezoar.

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