Ileal obstruction caused by a phytobezoar in an older adult

Objective: To describe ileal obstruction caused by a phytobezoar in an older adult and the diagnostic and postoperative challenges. Methodology: A descriptive single-patient case report presenting clinical findings, imaging, operative and pathological findings, treatment, and follow-up, with a narrative discussion of the literature. Results: An 80-year-old woman presented with severe abdominal pain and three days without stool or flatus. Examination revealed abdominal distension, marked tympany, and diffuse tenderness. C-reactive protein was 125 mg/L, with sodium and potassium within reference ranges. Computed tomography showed focal ileal narrowing, upstream dilatation, proximal ileal fecalization, and intraperitoneal fluid. Nasogastric decompression did not resolve the obstruction. Same-day laparotomy identified a phytobezoar with an estimated volume of 50 mL, which was removed through an enterotomy without ileal resection. Serosal injury 40 cm proximal to the ileocecal valve was repaired. Pathological examination identified material consistent with plant fibers. Postoperative ileus and acute pulmonary edema were managed medically. Bowel function returned on postoperative day six, and discharge occurred on day seven. At follow-up 20 days after discharge, the patient was asymptomatic. Conclusion: Phytobezoar should be considered despite the absence of previous surgery. Reassessment of persistent obstruction and careful adjustment of hydration and oral intake are important during postoperative recovery.