A 23-year-old woman with a history of an eating disorder complains of vomiting, nausea, and severe abdominal pain. Physical examination shows abdominal distension and constipation. An X-ray film of the abdomen reveals air-fluid levels and a hyperlucent shadow at the epigastric area. The material obstructing the gastrointestinal tract is removed surgically and shown. Which of the following is the most likely diagnosis?

## **Core Concept**
The patient's symptoms of vomiting, nausea, severe abdominal pain, abdominal distension, and constipation, along with the X-ray findings of air-fluid levels and a hyperlucent shadow, suggest a gastrointestinal obstruction. The presence of a hyperlucent shadow on the X-ray is particularly indicative of a bezoar, which is a collection of foreign material in the gastrointestinal tract.

## **Why the Correct Answer is Right**
The correct answer, , represents a bezoar, specifically a **phytobezoar**, which is a type of bezoar made of plant material. Bezoars can cause gastrointestinal obstruction and present with symptoms similar to those described in the scenario. The hyperlucent shadow seen on the X-ray is consistent with a bezoar, as it represents a mass of undigested material. Surgical removal of the obstructing material is often necessary to relieve the obstruction.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option does not accurately represent a bezoar or any other likely cause of the patient's symptoms based on the provided description.
- **Option B:** Similarly, this option does not match the clinical presentation or the radiographic findings indicative of a bezoar.
- **Option D:** This option also does not align with the symptoms and findings suggestive of a gastrointestinal obstruction caused by a bezoar.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **bezoars are a cause of gastrointestinal obstruction**, particularly in patients with a history of eating disorders or conditions that affect gastric emptying. The presence of a hyperlucent mass on abdominal X-ray should raise suspicion for a bezoar. Bezoars can often be treated with surgical or endoscopic removal.

## **Correct Answer:** . Bezoar.

✓ Correct Answer: D. Trichobezoar