{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:40:03Z","timestamp":1756305603937,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,1,17]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>A man in his 60s with a virgin abdomen presented with sudden-onset generalised abdominal pain and fevers. The night prior, he snacked on supermarket purchased dehydrated apples. CT abdomen and pelvis revealed small bowel obstruction (SBO) to the mid ileum and small amount of free fluid within the pelvis. The patient underwent emergency exploratory laparotomy. High-grade SBO was identified, caused by large obstructing phytobezoars, with three further proximal large phytobezoars identified. All four phytobezoars were extracted and found to be rehydrated pieces of dehydrated apple that had increased in size in the gastrointestinal tract. The patient was later found to have further phytobezoars in the stomach which passed conservatively. The patient recovered well. This case demonstrates the challenges of preoperative radiological diagnosis in phytobezoar-related SBO and the significance of enterotomy orientation and closure to ensure a safe repair to withstand the passage of any residual rehydrating phytobezoars.<\/jats:p>","DOI":"10.1136\/bcr-2023-256710","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T22:25:11Z","timestamp":1707258311000},"page":"e256710","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Small bowel obstruction caused by dehydrated apple ingestion: the challenges of preoperative radiological diagnosis and surgical management"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8636-1967","authenticated-orcid":false,"given":"Rama Hala Gamal","family":"Mikhail","sequence":"first","affiliation":[{"name":"Division of Hepatopancreato-Biliary and Liver Transplantation, General Surgery, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siobhan","family":"McKay","sequence":"additional","affiliation":[{"name":"Division of Hepatopancreato-Biliary and Liver Transplantation, General Surgery, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1476-0591","authenticated-orcid":false,"given":"Mark","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osamu","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Division of Hepatopancreato-Biliary and Liver Transplantation, General Surgery, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,6]]},"reference":[{"key":"2025082707132522000_17.2.e256710.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2013.09.034"},{"key":"2025082707132522000_17.2.e256710.2","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/TA.0000000000001941","article-title":"Deconstructing dogma: nonoperative management of small bowel obstruction in the virgin abdomen","volume":"85","author":"Collom","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082707132522000_17.2.e256710.3","doi-asserted-by":"crossref","DOI":"10.1186\/s13017-021-00379-8","article-title":"Diagnosis and management of small bowel obstruction in virgin abdomen: a WSES position paper","volume":"16","author":"Amara","year":"2021","journal-title":"World J Emerg Surg"},{"key":"2025082707132522000_17.2.e256710.4","doi-asserted-by":"publisher","DOI":"10.3393\/jksc.2012.28.2.89"},{"key":"2025082707132522000_17.2.e256710.5","doi-asserted-by":"crossref","unstructured":"Di Saverio S , Catena F , Coccolini F , et al . 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