Unusual cause of small bowel obstruction in a liver transplant recipient: a case report and focused literature review.

Authors

Anastasia Sotiropoulou, David Martin, Julien Vionnet, Amaniel Kefleyesus

Published in

Frontiers in surgery. Volume 13. Pages 1824834. Epub Jun 08, 2026.

Abstract

Small bowel obstruction (SBO) is a common surgical emergency. In transplant recipients, atypical etiologies may delay diagnosis and lead to suboptimal management.
We report a case of phytobezoar-induced SBO in a liver transplant recipient and conducted a focused narrative literature review (PubMed/MEDLINE, Embase, Cochrane Library, Google Scholar, OpenEvidence, Litmaps) of adult transplant patients with mechanical SBO reported up to January 2026.
A 60-year-old man with two prior liver transplantations (2012, 2022) presented with acute abdominal pain and vomiting after ingestion of wild mushrooms. Initial contrast-enhanced CT suggested adhesional SBO. After failure of conservative management, exploratory laparoscopy identified an intraluminal mass in the distal jejunum. Mini-laparotomy with enterotomy allowed extraction of a phytobezoar composed of Craterellus cornucopioides. Despite marked bowel congestion and equivocal conventional viability criteria, intraoperative indocyanine green (ICG) fluorescence confirmed adequate perfusion and avoided resection. Postoperative course was complicated by paralytic ileus, successfully reversed with neostigmine. The patient was discharged on postoperative day 14. The literature review retrieved one retrospective study and seven adult case reports; bezoars accounted for 5/7 cases, predominantly located at Roux-en-Y enteric anastomoses. ICG fluorescence had not been used in any previously reported case.
Bezoars are a rare but clinically relevant cause of SBO in transplant recipients. Early surgical exploration is warranted when conservative management fails or imaging is ambiguous. Intraoperative ICG fluorescence is a useful adjunct to assess bowel viability and may avoid unnecessary resection. Individualized dietary counseling adapted to regional habits should be considered in long-term transplant follow-up. Larger contemporary series are needed to refine the etiologic spectrum and preventive strategies in this population.

PMID:
42339171
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

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