Cats
An unusual case of small bowel obstruction in an elderly man recently admitted having suddenly developed expressive dysphasia, who was found to be in heart failure and fast atrial fibrillation, who made a satisfactory recovery.
Abstract
To the Editor:-We report an unusual case of small bowel obstruction in an elderly man. A previously fit, edentulous man of 87 years was recently admitted having suddenly developed expressive dysphasia. He was found to be in heart failure and fast atrial fibrillation. After treatment with digoxin and diuretics his heart failure improved and he returned to sinus rhythm. There was no evidence of myocardial infarction. He remained dysphasic but was soon mobile without aids and self-caring. On the day before his projected date of discharge, he developed vomiting and abdominal pain and was found to have small bowel obstruction. At surgery, the bowel was dilated to 30 cm proximal to the ileocecal valve, where there was an intraluminal cystic obstruction. A proximal enterotomy was performed and an intact grape, the cause of the obstruction, was removed. There was no evidence of any small bowel pathology. Thereafter, he made a satisfactory recovery. Food bolus obstruction occurs rarely in the large bowel, usually with constricting colonic lesions, or in one remarkable case in a man with a normal rectum that was obstructed by an aggregation of 1010 cherry seeds. * However, up to 2% of all cases of small bowel obstruction are due to f ~ o d . ~ , ~ Of the known contrib-