Small Bowel Obstruction in Intellectual Impairment-Time to Revisit: Case Report Takako Eva Yabe * , Suren Subramaniam and Bruce Ashford Department of General Surgery, Wollongong Hospital, New South Wales, Australia * Corresponding author: Takako Eva Yabe, Department of General Surgery, Wollongong Hospital, New South Wales, Australia, Tel: 02-4255-1346; E-mail: takakoyabe424@gmail.com Received date: October 14, 2017; Accepted date: November 02, 2017; Published date: November 09, 2017 Copyright: ©2017 Yabe TE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Clinical assessment of people with intellectual disability is challenging to the treating clinicians, mainly because these patients are unable to provide an accurate history of their presenting symptoms. In this report, we describe a case in which we faced a diagnostic dilemma before reaching a decision on definitive management. Case presentation: A 57 year old woman with cognitive impairment from a group home was admitted to hospital with abdominal distension, anorexia and malaise. She had a surgical intervention for trichobezoar many years ago. Her bowel habits were reported to be normal. On examination, she had a distended but non-tender abdomen. A computed tomography (CT) scan showed a small bowel obstruction (SBO). She responded to conservative management and was discharged. She presented a third time 4 weeks later with the same problem. This time, however, she looked lethargic and her biochemistry results were slightly abnormal. A CT scan was performed, which confirmed complete SBO with a clear transition point in the distal small bowel within the pelvis and faecalisation of the small bowel. We decided that, because of her multiple presentations to the hospital with the same symptoms and worsening faecalisation on CT scan, she would benefit from exploratory laparotomy. During surgery, an obstructing mass was identified that was found to be a calcified latex glove. The patient had an uncomplicated post- operative recovery and has not presented to the hospital since then. Conclusion: A trichobezoar should be suspected and investigated in intellectually impaired patients with gastrointestinal symptoms. Environmental modifications, a neuropsychiatric review and a multidisciplinary approach involving all care-givers should be considered in an effort to avoid this potentially life-threatening complication in a most vulnerable group. Keywords: Bowel obstruction; Intellectual disability; Foreign body; Trichobezoar Abbreviations CT: Computed Tomography; SBO: Small Bowel Obstruction Background Small bowel obstruction (SBO) is a life-threatening condition in which the normal enteric fow is impaired due to mechanical blockage of the small intestine [1]. It is most commonly caused by adhesions from previous abdominal surgery, hernia, intussusception or malignancy [2]. Patients with SBO usually present with abdominal pain, distension, nausea, vomiting, constipation and/or obstipation [3]. Bezoars are a well-recognised cause of intraluminal SBO in children and the intellectually impaired [4]. Few cases of bezoar-induced SBO have been reported in the last decade, the most recent series on the subject having been published in 1994 [5]. Tis may represent a true reduction in incidence, although with the improved general care of this group, we would expect incidence rates to increase. We present what is only the second reported case of a glove used by care providers as the primary reason for the development of a bezoar. Intellectually impaired patients may be more inclined to ingest foreign objects, are ofen unable to provide a thorough history and can present special challenges during examination. With the signifcant morbidity and mortality that can complicate such presentations, it is important for treating doctors to be aware of this possible aetiology [6]. In addition, care providers in group homes should be alert to the dangers of swallowing non-digestible foreign bodies. Case Presentation Case description A 57 year old woman with cognitive impairment from a group home was admitted to a regional hospital in Australia, New South Wales, with abdominal distension, anorexia and malaise. She had a background of previous laparotomy and enterotomy for a trichobezoar many years ago. Her bowel habits were reported to be normal. She was aphasic and fully dependent on a carer for activities of daily living. On examination, she was haemodynamically stable and afebrile. Her abdomen was distended but sof and non-tender. Biochemistry results were all within normal range. A computed tomography (CT) scan was performed, which showed a possible transition point in her pelvis. As she had previous abdominal surgery in 2004, her transition point was thought to be due to adhesions. She was admitted under the care of the general surgical team for management of adhesive SBO. She responded to conservative management and was discharged to her group home 3 days later. She presented to us again 2 weeks later with the same symptoms of abdominal distension and poor appetite, but no obvious H e a l t h C a r e : C u r r e n t R e v i e w s ISSN: 2375-4273 Health Care : Current Reviews Yabe et al., Health Care Current Reviews 2017, 5:4 DOI: 10.4172/2375-4273.1000212 Case Report Open Access Health Care Current Reviews, an open access journal ISSN:2375-4273 Volume 5 • Issue 4 • 1000212