Bezoar-Induced Small Bowel Obstruction in a Patient With a Remote History of Gastric Bypass: A Case Report.

Bezoar-induced small bowel obstruction (SBO) remains an uncommon but important consideration in patients with prior Roux-en-Y gastric bypass (RYGB), where altered gastrointestinal anatomy predisposes to impaired digestion of fibrous foods. Thus, we present a case of a 50-year-old woman with recurrent SBO who developed an acute obstruction requiring surgical intervention. Imaging suggested SBO without a clear etiology, and intraoperative exploration identified an obstructing intraluminal mass in the terminal ileum, presumed to represent a seed-containing phytobezoar based on its gross appearance and the patient's subsequently obtained dietary history. The procedure began as a diagnostic laparoscopy and was converted to exploratory laparotomy with extraction of the obstructing intraluminal mass through an enterotomy, followed by primary closure. The involved bowel remained viable, without evidence of ischemia. This case highlights the diagnostic challenge of bezoar-related SBO, as imaging findings are often nonspecific, and emphasizes the importance of timely operative evaluation and management in appropriately selected patients. It also underscores the potential role of dietary factors, including seed consumption in this case, in bezoar formation and the need for targeted nutritional counseling in post-bariatric populations to reduce recurrence risk.