Psyllium Granule–Induced Esophageal Impaction After Fundoplication Reversal: A Case Report and Literature Review

Introduction: Constipation is one of the most common gastrointestinal complaints and is frequently treated with bulk-forming laxatives such as psyllium. Psyllium-based granules are hydrophilic fiber derivatives that absorb water and expand in volume. Although generally considered safe, these agents can rarely cause gastrointestinal obstruction when ingested without adequate liquid or in patients with impaired esophageal transit Case Presentation: We report the case of a 58-year-old man with a history of Nissen fundoplication followed by surgical reversal due to persistent postoperative dysphagia. He presented with acute retrosternal pain, dysphagia, and regurgitation of fluids shortly after ingesting psyllium granules (Agiolax). Upper gastrointestinal endoscopy revealed a large firm bolus obstructing the distal esophagus. Endoscopic fragmentation using a cold snare allowed partial advancement of fragments into the stomach and partial retrieval through the esophagus. No immediate complications occurred. Conclusion: Psyllium-based bulk laxatives may rarely cause esophageal obstruction, particularly in patients with underlying esophageal structural or motility abnormalities. Prompt endoscopic evaluation allows both diagnosis and definitive treatment. Careful patient counseling regarding adequate fluid intake and screening for dysphagia are important preventive measures.