Patient was a 29-year-old female coming with chief complaints of pain in abdomen since 1 year which was colicky in nature, present all over abdomen, non-radiating. The pain aggravated on eating food. Patient also noticed a lump in her abdomen since past 1 year. History of 1-2 episodes of non-bilious vomiting on and off. History of loss of appetite and weight loss since 1 year. Patient gave a past history of similar complaints 12 years back for which she was admitted and diagnosed with abdominal tuberculosis. She was operated for the same but no documentation was available. Patient was also given 18 months of AKT therapy.
On Examination, she was afebrile. Her pulse was 86/mins and her Blood Pressure was 120/80 mmHg. Per Abdomen examination revealed a lump of size 8 x 5 cm at umbilical and hypogastric region. Skin over the lump was normal. Lump was mobile did not move with respiration. Tenderness was present over lump site. Guarding was present. There was no local rise of temperature at the lump site. Dull note was present on percussion. Auscultation revealed bowel sounds at the lump site. A midline vertical scar was present indicative of previous surgery.
X ray abdomen was inconclusive. Ultrasound abdomen revealed linear echogenicity with post acoustic shadowing in the abdomen with features likely suggestive of calcified mass.
CECT Abdomen revealed an ill-defined mass with calcification and air foci in jejunum loop suggestive of bezoar with likely intussusception and focal inflammatory changes.
Following the CT report, a psychiatric evaluation was done for this patient to rule out trichotillomania, pica or any eating disorders. Patient's psychiatric evaluation did not reveal any such abnormalities.
Patient was prepared for surgery and was performed by an Associate Professor with 20 years of experience in the field of general surgery and was assisted by two junior residents with 3 years of specialized training.
Abdomen was opened and the bowel was inspected. Evidence of previous bowel anastomosis was seen. Hard lump was felt within the bowel loop. Enterotomy was performed. There was presence of hard material inside the bowel. Bowel was milked and hard material was pulled out of the bowel. Upon cleaning and further inspection, the hard material was recognized as swabs retained from previous surgery. Two swabs were removed from the intestine. The intestine was properly washed and closed. Warm saline wash was given and the abdomen was closed.
Patient recovered well postoperatively and was put on full oral diet on day 5. Patient's weight was recorded on discharge and after 1 month of follow up. An increase of 5 kg weight was recorded. Patient also noted relief of previous symptoms and also had an increased appetite.