Image Challenge #6

A 40-year-old male presented with repeated vomiting and colicky abdominal pain. X-Ray showed multiple air fluid levels. Patient underwent surgery for gastric ulcer in the form of gastrojejunostomy (bypass) and vagotomy. During surgery, a vague foreign body inside the terminal ileum was found.

What is the most likely diagnosis?   

Presented by Dr. Dildar Haji Mosa, Assistant professor in general surgery, college of Medicine, Duhok University

Answer: Phytobezoar