Small bowel obstruction caused by dried apple

• Small bowel obstruction in a virgin abdomen can be caused by food bezoar such as rehydrated fruits.
• Dried apple has a potential to reabsorb fluid and expand up to 35% of its initial size within 72 h.
• The most common site of small bowel obstruction is proximal to ileocecal valve.

IntroductionSmall bowel obstruction in a virgin abdomen is an uncommon surgical condition. While malignancy, inflammatory bowel disease and foreign body are the main reported causes, undigested food bezoar causing bowel obstruction is a rare entity. We report a case of small bowel obstruction secondary to dried preserved apple having re-expanded within the gastrointestinal tract.Presentation of caseA 69 year old male presented with severe abdominal distension, generalized abdominal tenderness and obstipation for 1 week. Small bowel obstruction (SBO) was confirmed on plain abdominal X-ray and CT imaging. An emergency explorative laparatomy identified a sausage-shaped intra-luminal foreign body obstructing the distal ileum. An enterotomy was performed which revealed a rehydrated, donut-shaped piece of dried apple.DiscussionSwallowed items that pass through the pylorus rarely cause obstruction as they are usually small enough to pass through the rest of the bowel without difficulty. We postulate that in our patient that the dried apple was originally small enough to pass through the pylorus. However during small bowel, its’ highly absorbable nature resulted in an increase in size that prevented its’ passage through the ileocecal valve. A simple in-vitro experiment discovered that dried apple has a potential to reabsorb fluid and expand up to 35% of its initial size within 72 h.ConclusionThis report illustrates the potential for dried food substances to cause intra-luminal SBO after significant expansion with rehydration.