S6071 How Bezoar! A Rare Case of Small Bowel Bezoar

Introduction: Bezoars are accumulations of undigested fibrous material in the gastrointestinal (GI) tract that most often occur in the stomach. Extra-gastric bezoars are rare. We present a case of terminal ileum bezoar in a patient with prior ileocecectomy. Case Description/Methods: A 55-year-old man with Crohn’s disease and prior ileocecectomy was referred by surgery for small bowel bezoar. He had undergone ileocecectomy 15 years prior with multiple subsequent small bowel obstructions. Imaging showed a large bezoar in the neoterminal ileum proximal to the anastomosis. He was referred to GI for endoscopic management. The patient underwent 10 colonoscopies to break apart the bezoar, which initially measured ∼6 × 15 cm. Forceps, snares, balloons, and APC were used to fragment the bezoar, but progress was limited by its hard outer shell and mobile nature. In later procedures, large portions were removed. Days after his tenth colonoscopy, the patient developed rectal pain. Exam revealed a rectal bezoar, which was manually fragmented and removed. He has since remained symptom-free. Discussion: Small bowel bezoars are rare, causing only 4% of all SBO-related hospitalizations. This case highlights an unusual presentation of an ileal bezoar in a patient with abnormal anatomy. Bezoars are typically gastric and linked to delayed motility or prior gastric surgery. Though colonic and rectal seed-bezoars have been reported, these occur mostly in children or those with high-seed diets. This case presents several considerations. The patient’s altered anatomy from ileocecectomy likely predisposed him to bezoar formation, and while bezoars are not common in Crohn's disease, enterolithiasis is a known complication caused by strictures and stasis. It is plausible that narrowing at the anastomosis or unknown proximal strictures contributed to the formation of this patient's bezoar. Bezoars should be considered in patients with recurrent obstruction and a history of bowel surgery or Crohn’s disease, as timely endoscopic evaluation may offer both diagnosis and effective treatment.