Rare Small Bowel Obstruction Caused by a Plant-Matter Bezoar and Live Isopod
The patient: An 82-year-old woman from Bologna, Italy.
The symptoms: The woman was hospitalized after experiencing worsening abdominal pain for four days. She also had constipation, nausea and vomiting—symptoms that can indicate a small bowel obstruction, or a blockage in the small intestine.
What happened next: During a physical examination, doctors found that the patient’s abdomen was distended and tender. Blood tests showed an elevated white blood cell count, which can be a sign of inflammation or an immune response to infection.
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An abdominal X-ray showed that some sections of the woman’s intestines were expanded by gas or fluid, while other sections had collapsed. A CT scan then revealed a solid mass blocking intestinal loops on the right side of her abdomen. Doctors diagnosed a small bowel obstruction, also known as an SBO.
The diagnosis: Small bowel obstructions can have several causes. Tumors may block the intestine, while a section of bowel can twist into a condition called a volvulus. A hernia can also push tissue through a weakened area of the intestinal wall.
According to a case report, an SBO can occasionally be caused by a foreign body. Possible examples include swallowed objects, gallstones that enter the intestine, masses of parasites and bezoars—solid clumps of undigested material that accumulate in the digestive tract.
A complete, untreated bowel obstruction can become life-threatening. Doctors recommended emergency surgery to remove the blockage and reduce the risk of intestinal strangulation. This complication occurs when the blood supply to part of the intestine is cut off, potentially causing tissue death.
Gallstones are one possible cause of a small bowel obstruction.
The treatment: Surgeons performed a laparotomy, an operation that involves making an incision in the abdomen to reach the intestines. They located and removed the obstructing mass, which measured about 2 inches (5.5 centimeters) long.
The mass was a phytobezoar, a type of bezoar made from plant material. As surgeons removed it, they noticed what appeared to be a small live insect jumping from the vegetable matter and crawling across the sterile surgical drapes.
The medical team captured the creature and sent it to a laboratory for identification. It was not an insect but a terrestrial crustacean belonging to the order Isopoda. Isopods are relatives of crabs and shrimp. Land-dwelling species have flattened, segmented bodies, rigid exoskeletons and seven pairs of legs.
Terrestrial isopods are found worldwide and are known by many common names, including pill bugs, sow bugs, roly-poly bugs and woodlice. In the United Kingdom, regional names include chucky pig, monkey pea, cheese log, daddy granfer and granny grunter.
Because land isopods feed on decaying vegetation, the doctors suggested that the patient may have accidentally swallowed the crustacean along with unwashed vegetables or fruit. The plant matter may have formed a protective capsule around it, allowing the isopod to remain alive temporarily inside the digestive tract.
The woman recovered after surgery and later moved to a retirement home. She was still living there 18 months after the operation, according to a follow-up visit described in the case report.
What makes the case unusual: Foreign bodies such as bezoars account for only a minority of small bowel obstruction cases. In adults over age 50, common causes include conditions such as volvulus. A live terrestrial isopod found inside a phytobezoar causing an intestinal blockage is exceptionally rare.
The isopod group includes more than 11,000 species, and approximately half live in the ocean. Some marine isopods are parasites of fish, including species that consume and replace a fish’s tongue. However, the doctors noted that no terrestrial isopod is known to parasitize humans.
If someone accidentally swallows a nonvenomous insect, spider or other small arthropod, the digestive system generally breaks it down using stomach acids and digestive enzymes. In this unusual case, the compressed plant material surrounding the isopod may have offered temporary protection.
For more unusual medical cases, explore our Diagnostic Dilemma archives.
This article is for informational purposes only and is not intended to provide medical advice.
Di Saverio, S., Catena, F., Coccolini, F., Gazzotti, F., Filicori, F., & Ansaloni, L. (2010). Bizarre behaviour, bizarre intruder and bizarre bowel obstruction. BMJ Case Reports, 2010, bcr1120092486. Read the case report
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