Banana in a Condom: An Unusual Cause of Small Bowel Obstruction - Cureus

An different steadfast antheral with a past of slump presented to the exigency section with abdominal pain, nausea, and vomiting. His symptoms began respective hours anterior to the presumption and consisted of progressively worsening, non-radiating, generalized abdominal pain, accompanied by nausea and non-bloody emesis. He denied immoderate identifiable aggravating oregon relieving factors. He had been incapable to tolerate immoderate nutrient oregon fluids but continued to walk flatus, though decreased from his baseline. His past bowel question was connected the time anterior to the onset of symptoms. He admitted to having swallowed a banana stuffed successful a condom amidst a “hormonal rage” astir 24 hours anterior to his presentation. He denied thorax pain, hematemesis, oregon hematochezia. He denied intent of self-harm oregon anterior past of overseas assemblage ingestion. He had nary past of abdominal country oregon different aesculapian conditions. He did not instrumentality immoderate medications and denied the usage of baccy oregon illicit drugs. He reported consuming 1 alcoholic beverage per week.

On examination, the diligent was alert, afebrile, and mildly hypotensive. His abdomen was mildly distended. On palpation, diffuse tenderness and guarding were present. The bowel sounds were decreased. The remainder of the carnal exam was different unremarkable. Laboratory studies showed a achromatic humor compartment number of 18.4 K/mm³ (normal: 3.7 - 10.5 K/mm³) and hemoglobin of 18.2 g/dL (normal: 13.2 - 17.7 g/dL). The basal metabolic panel, liver relation tests, and lactic acerb were unremarkable.

During the evaluation, the diligent became diaphoretic and hypotensive with systolic humor unit successful the 60s (mmHg). He past had 2 episodes of large-volume, non-bloody emesis. Administration of 1 liter of mean saline was initiated, and helium had consequent betterment of systolic humor unit to the 100s (mmHg). A contrast-enhanced computed tomography (CT) of the abdomen and pelvis was notable for tiny bowel dilation up to 3.5 cm with fecalization, adjacent to a modulation constituent successful the near little quadrant (Figures 1-2, Video 1). These findings were accordant with tiny bowel obstruction. A tiny magnitude of ascites was besides present, concerning for bowel distress. Hence, the wide country work was consulted.

Given the severity of the obstruction and interest for bowel distress, an exploratory laparotomy was indicated implicit expectant management. The diligent was started connected antibiotic prophylaxis with cefazolin and metronidazole and was placed nether wide anesthesia. Upon entering the peritoneum, small-volume ascites was visualized. Samples were obtained and cultured, which aboriginal grew Cutibacterium acnes. Examination of the tiny bowel identified high-grade obstruction successful the jejunum, wherever an evident overseas assemblage was palpable, with an acute modulation point. A 1-cm enterotomy was made proximal to the overseas assemblage and the overseas assemblage was removed intact (Figure 3). The enterotomy was closed transversely. Re-examination of the tiny bowel from the ligament of Treitz to the cecum did not place immoderate different overseas assemblage oregon masses. The abdomen was irrigated, followed by closure by layers. The diligent tolerated the process good and his postoperative betterment was uneventful. He was capable to tolerate oral intake and had a instrumentality of bowel function. He was discharged connected postoperative Day 3 without complications.

Two weeks aft the operation, helium was tolerating a low-fiber fare without nausea oregon vomiting. He had a instrumentality of mean bowel movements, and his symptom was well-controlled. At six months, helium continued to endorse mean bowel patterns and diet. He was capable to dilatory resume his progressive manner and did not person large concerns.

Previous reports of condom ingestion person mostly been related to the proscription (body packing) oregon concealment (body stuffing) of illicit drugs [3,4]. Most cases are asymptomatic and tin beryllium managed conservatively [5-7]. However, determination are respective reports of surgical indications successful asymptomatic patients erstwhile spontaneous elimination fails, owed to the hazard of condom rupture associated with prolonged retention successful the tummy [8,9]. Serious complications, specified arsenic cause toxicity, whitethorn hap pursuing the rupture of the condom [10,11]. Chest pain, hypertension, tachycardia, and arrhythmias are often seen successful cocaine intoxication, whereas heroin intoxication whitethorn nutrient sedation and respiratory depression.

Intestinal obstruction is different superior complication resulting from assemblage packing oregon stuffing described successful respective reports [9,12,13]. An adjacent much antithetic origin of gastrointestinal obstruction is the ingestion of condoms filled with substances different than drugs. Few reports of ingested, fluid-filled condoms causing tiny bowel obstruction person been described. In 1 case, a diligent reported a sensation of swallowing marbles portion participating successful a beer-drinking contention [14]. After failing to amended with blimpish management, a laparotomy with consequent enterotomy was performed to region 2 4-cm, fluid-filled condoms [14]. Another lawsuit describes a akin country performed to region a fluid-filled condom, swallowed arsenic portion of a YouTube challenge, that led to the obstruction of the distal jejunum [15]. Others person reported a little invasive method of image-guided transcutaneous tapping of fluid-filled condoms erstwhile easy accessible. Tapping nether ultrasound guidance was performed connected 1 diligent who was admitted for swallowing a water-filled condom [16]. Another lawsuit describes a diligent who swallowed a beer-filled condom portion astatine Munich Octoberfest; CT-guided transabdominal tapping was performed aft unsuccessful efforts to region the condom by precocious endoscopy [17].

A lit hunt connected condom-related intestinal obstructions yielded galore reports of cases wherein the condom was filled with drugs; fewer reports, however, progressive fluid-filled condoms. To the champion of our knowledge, the contiguous lawsuit appears to beryllium the archetypal lawsuit successful which a condom containing a banana was swallowed. Drug toxicity associated with condom rupture was, therefore, not a interest successful our lawsuit arsenic is seen successful the mounting of assemblage packing oregon stuffing. Our diligent underwent laparotomy and enterotomy arsenic transcutaneous attraction was not an enactment careless of accessibility fixed the coagulated consistency of a banana arsenic compared to fluids.