Small Bowel Obstruction in a Virgin Abdomen: A Case Report

Small bowel obstruction (SBO) is a major cause of morbidity and financial burden in hospitals around the world. Foreign body (FB) ingestion as a cause is rare. While most cases are straight forward, some can be extremely subtle. We present a case of SBO caused by an undigested piece of pineapple core.


Introduction
Patients presentation after foreign body ingestion is usually straightforward and 80% of ingested foreign bodies reaching the stomach will pass spontaneously [1]. Surgery should be reserved for those who have an acute abdomen [2]. We present a case of small bowel obstruction secondary to undigested pineapple core.

Case Presentation
A 52-year-old female with no past medical or surgical history presented to our emergency room with two days history of abdominal pain, nausea, vomiting and obstipation. The patient had a distended abdomen, discomfort on deep palpation, with no peritoneal signs. Her white blood cell count was mildly elevated and low potassium was replaced. Computed tomography was concerning for small bowel obstruction ( Figure 1). 1 2 1 1 1

FIGURE 1: CT scan abdomen.
Consistent with small bowel obstruction. Distended small bowel loop (Red arrow).

CT: Computed tomography
The patient was admitted to the hospital and small bowel follow-through the following day revealed moderate distention of the stomach, multiple distended small bowel loops and no evidence of contrast in the cecum at 14 hours consistent with small bowel obstruction ( Figure  2).
The patient was taken to the operating room, and exploratory laparotomy with retrieval of a foreign body via an enterotomy was performed ( Figure 3).
The patient recalled ingesting pineapple core as a source of fiber the day prior to her symptoms. She did well and was discharged from the hospital.

Conclusions
Patients' presentation after foreign body ingestion is usually straightforward but on occasions can be extremely subtle. Pineapple core is a good source of fiber, however, the ingestion of large undigested pieces led to an intestinal obstruction in our patient.

Additional Information Disclosures
Human subjects: Consent was obtained by all participants in this study.

Conflicts of interest:
In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.