Phytobezoar in a Meckel’s Diverticulum Associated with Recent Adoption of a Paleolithic Diet

Case Report

Austin J Surg. 2014;1(4): 1018.

Phytobezoar in a Meckel’s Diverticulum Associated with Recent Adoption of a Paleolithic Diet

Xiang M1, Mazer LM1,2, Gupta A1,2 and Odom SR1,2*

1Department of Surgery, Harvard Medical School, USA

2Department of Surgery, Beth Israel Deaconess Medical Center, USA

*Corresponding author: Odom SR, Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

Received: June 13, 2014; Accepted: July 21, 2014; Published: July 26, 2014


A healthy 33 year old male who had three weeks ago adopted a Paleolithic, or “paleo’ diet, presented with nausea and vomiting. Computed tomography identified a complete small bowel obstruction (SBO) that failed to resolve after initial conservative management. At surgery he was found to have a phytobezoar in conjunction with a Meckel’s diverticulum. We report the first known case of phytobezoar in association with recent adoption of the Paleolithic diet. We discuss the Paleolithic diet as an increasingly significant fad diet in the United States. Furthermore, we discuss diagnostic clues on pre-operative history, physical examination and radiography that may lead to early recognition such as the bowel target sign. Finally, we suggest surgical management (either open, as in this case, or laparoscopic) as treatment and describe our experience in this case of milking the bezoar into the Meckel’s diverticulum prior to resection of the entire lesion. In conclusion, we warn of a possible association between an increasingly used fad diets (1-3 million Americans currently subscribe to the “paleo’ diet), Meckel’s diverticulum (2% of the population) and phytobezoar.

Keywords: Phytobezoar; Paleolithic diet; Diverticulum

Case Presentation

A previously healthy 33 year-old male presented with a one day history of nausea, crampy abdominal pain, and obstipation. He had a laparoscopic appendectomy at age 17. Three weeks prior, he started the Paleolithic diet and had been eating large quantities of salad, carrots, and zucchini. Examination revealed moderate periumbilical and right lower quadrant tenderness with voluntary guarding and no rebound. Vital signs, basic metabolic panel, and complete blood count were within normal limits. Computed tomography of the abdomen revealed complete small bowel obstruction (SBO) with concern for intussusception (Figure 1). He was admitted and treated with nasogastric decompression, intravenous fluid hydration, and bowel rest. Due to persistent pain and no return of bowel function after two days, he was taken to the operating room for exploratory laparotomy. An impacted phytobezoar was discovered obstructing the intestinal lumen 2cm distal to a previously unappreciated Meckel’s diverticulum (Figure 2). The bezoar was manually retropulsed into the diverticulum, which was resected, followed by primary side-to-side anastomosis. Post resection, the bezoar was noted to conform to the walls of the diverticulum (Figure 3). The patient tolerated the procedure well, and was discharged home after return of bowel function. At 1 month follow-up, he had recovered fully with no recurrence of SBO.