Diagnosis of Bezoar-induced small-bowel obstruction on sonography in emergency department

Bezoars are defined as indigestible foreign materials impacting in the gastrointestinal tract, which are classified according to what they are composed of. Small intestinal obstruction caused by bezoar impaction was a rare disease. However, it has become more and more recognized since gastrectomy with truncal vagotomy was introduced into the treatment of peptic ulcer disease. Computerized tomography (“CT”) is still the imaging modality of choice in preoperative diagnosis of small bowel obstruction caused by bezoars. Although ultrasound has less sensitivity and specificity in detecting bezoars as compared with CT, it still can reveal bezoars in 88% of patients. Some case reports have addressed the role of sonographic detection of small intestinal phytobezoar. Ultrasonography may be a more available and time saving tool when used as a “screening” modality at emergency department for patients with mild persistent nonspecific abdominal pain but without definite peritoneal signs, especially when presence of past history of gastrectomy with truncal vagotomy.