S6147 A “Bezoar” Set of Events: A Case of Small Bowel Obstruction Due To Dried Apricots Bezoar

Introduction: Bezoars are conglomerates of indigestible material that accumulate in the gastrointestinal tract, often leading to symptoms such as pain, obstruction, or nausea. Small bowel obstruction due to bezoars are less frequent and often associated with prior gastric surgery or impaired motility. Apricot pits, though rarely reported, can act as a nidus for bezoar formation due to their hard, fibrous structure. We present a rare case of small bowel obstruction caused by an apricot pit-induced bezoar, emphasizing diagnostic challenges and management. Case Description/Methods: A 66-year-old woman with a past medical history of coronary artery bypass grafting, tubal ligation and ischemic cardiomyopathy presented with abdominal pain, nausea and vomiting. Labs on arrival were essentially unremarkable, however x-ray and computed tomography scan of the abdomen revealed small bowel obstruction of the lower abdomen. General surgery was consulted, a nasogastric tube was inserted for bowel decompression and serial abdominal exams were conducted. Due to persistent and worsening symptoms, the general surgery team performed an exploratory laparotomy and removed a foreign body that appeared to be a clump of dried apricots. However, the patient's symptoms continued to worsen and was then taken back to surgery 2 days later where they found a bezoar and ultimately removed it. Patient’s abdominal pain, nausea, and vomiting dramatically improved following the 2 exploratory laparotomies. She was discharged home in stable condition. Discussion: Bezoars account for less than 4% of small bowel obstructions, with phytobezoars being the most common type. Apricot pits are an unusual cause but can lead to obstruction, especially in patients with prior gastrointestinal surgery or delayed motility. In this case, the patient presented with signs of mechanical obstruction, and imaging revealed an intraluminal mass. Surgical intervention is required in up to 50% of small bowel bezoar cases, particularly when complete obstruction occurs. Endoscopic retrieval is typically not feasible for distal small bowel bezoars. This case underscores the importance of considering bezoars in the differential diagnosis of small bowel obstruction, particularly in high-risk individuals.