BRIEF COMMUNICATION Case Report: Phytobezoar Causing Gastric Outlet Obstruction as a Late Complication After Biliopancreatic Diversion with Duodenal Switch Simone Zwicky 1 & Werner Inauen 2 & Urs Pfefferkorn 3 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Case report of a phytobezoar causing gastric outlet obstruction as a late complication after biliopancreatic diversion with duodenal switch, review of the literature and discussion of bezoars as a differential diagnosis in patients after bariatric surgery presenting with signs of intestinal obstruction. Keywords Bezoar . Phytobezoar . Case report . Biliopancreatic diversion . Duodenal switch . Sleeve gastrectomy . Gastroscopy . Endoscopic fragmentation . Instestinal obstruction after bariatric surgery Introduction Intestinal obstruction is a common complication after bar- iatric surgery. In bypass procedures such as laparoscopic Roux-en-Y gastric bypass or biliopancreatic diversion, an overall incidence of about 2 to 15% is described. The total incidence of intestinal obstruction after bariatric surgery is unknown [1–3]. After purely restrictive operations, the intestinal obstruction rate is due to missing risk of internal hernia much lower. The most frequent causes of small bowel obstruction after bariatric surgery are internal hernias, adhesions, and intestinal intussusceptions. Patients usually present with colicky ab- dominal pain, nausea, and vomiting. Computed tomography (CT) or diagnostic laparoscopy is recommended for diagnosis. Therapy typically consists of laparoscopic resolution of the mechanical problem. A rare differential diagnosis in patients with abdominal complaints is an intestinal obstruction caused by bezoar. Since patients after bariatric surgery are at risk of developing bezoars and the treatment is often non-operative, it is important to include this entity as differential diagnosis [4]. There are few reports of bezoar formation after sleeve gastrec- tomy, Roux-en-Y-bypass, and laparoscopic adjustable gastric bands [4, 5]. To the authors’ knowledge, there is no report of bezoar formation after biliopancreatic diversion so far. Methods We report a case of a phytobezoar causing gastric outlet ob- struction as a late complication after biliopancreatic diversion with duodenal switch. Results A 51-year-old woman with a BMI of 24.2 kg/m 2 presented with acute onset of nausea, emesis, and epigastric pain. She had undergone a Toupet fundoplication and a sleeve gastrectomy within the same intervention 14 years ago (initial BMI 40.1 kg/ m 2 ). Three years later, a biliopancreatic diversion with duodenal switch (common channel 60 cm, alimentary channel 220 cm) * Urs Pfefferkorn urs.pfefferkorn@spital.so.ch Simone Zwicky simone.zwicky@spital.so.ch Werner Inauen werner.inauen@spital.so.ch 1 Department of Surgery, Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500 Solothurn, Switzerland 2 Department of Gastroenterology, Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500 Solothurn, Switzerland 3 Department of Surgery, Kantonsspital Olten, Baslerstrasse 150, CH-4600 Olten, Switzerland Obesity Surgery https://doi.org/10.1007/s11695-020-04531-2