The symptoms: The woman was admitted to the hospital with abdominal pain that had worsened over the previous four days. The symptom was accompanied by constipation and episodes of nausea and vomiting.
When doctors performed an abdominal X-ray, they discovered that parts of the woman's intestines had expanded due to gas or fluid, while other portions of her intestines had collapsed. An abdominal CT scan revealed that the woman had a solid object blocking her intestinal loops on the right side — a situation known as a small bowel obstruction (SBO).
However, in a report of the case, the doctors wrote that SBOs can sometimes be foreign bodies, such as swallowed objects; gallstones that migrate to the intestines; packed masses of parasites, like roundworms or nematodes; or bezoars, which are solid clumps of undigested matter that collect in the gastrointestinal system.
Gallstones (pictured) are one potential cause of small bowel obstruction. (Image credit: Roblan | shutterstock)
The treatment: Surgeons performed a procedure called a laparotomy, making a small abdominal incision to access the patient's intestines. They then pinpointed the location of the mass and surgically removed it. The object measured just over 2 inches (5.5 centimeters) long and was a phytobezoar, meaning a bezoar composed of plant material.
The medical team captured the live intruder, sent it to a lab for analysis and learned that it was not an insect but rather a different type of land arthropod in the order Isopoda. These animals are crustaceans, relatives of crabs and shrimp. Terrestrial isopods have flattened bodies with rigid, segmented exoskeletons and seven pairs of legs.
Isopods feed on decaying vegetation, and the doctors hypothesized that the patient had accidentally swallowed the isopod along with a mouthful of unwashed vegetables or fruit.
What makes the case unique: Only about 25% of all SBO cases are caused by foreign bodies such as bezoars; in people over age 50, the most common SBO is a volvulus.
Related storiesThe isopod group contains more than 11,000 species, of which about half live in the ocean. Some of those marine isopods parasitize fish, such as the tongue biter that consumes and then replaces its host fish's tongue. However, no terrestrial isopod is known to parasitize humans, the physicians wrote in the report.
For more intriguing medical cases, check out our Diagnostic Dilemma archives.
Can you guess the diagnosis in these strange medical cases? Find out with our diagnostic dilemma quiz!
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