A 65-year-old man with a history of radical prostatectomy and cyst-gastrostomy for pancreatic pseudocyst presented with small bowel obstruction. He failed to resolve with NG tube decompression and underwent laparotomy. There was a loop of jejunum (deserosalized area) adherent to the underside of the midline incision. The bowel distal to the adhesion was decompressed. Immediately proximal to the adhesion, there was a mass of fibrous small bowel content (dilated segment of proximal bowel). After the fibrous material was mechanically milked distally, the adhesed area was reserosalized transversely.
On subsequent questioning, the patient revealed a recent history of eating oriental food. Patients with narrowing of the bowel due to adhesions or Crohn's disease or an iliostomy can present with mechanical obstruction from pileup of the undigested fiber. Breakup of such a fiber dam is a probable mechanism in the many small bowel obstructions that resolve spontaneously. Crohn's patients with narrowed segments are advised to limit fiber intake, and similar advice is prudent in patients who have had episodes of obstruction due to adhesions.
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