An undigested garlic clove induced gastric outlet obstruction: A case report

Abstract

Hypertension is a widespread global health issue, and dietary modifications are an important nonpharmacologic approach to its management. Increasing the consumption of fiber-rich foods, such as fruits, vegetables, and garlic, has been shown to reduce blood pressure and improve cardiovascular health. People consume garlic for proposed benefits, including management of hypertension. Rarely, excessive intake of these foods can lead to gastrointestinal complications, including the formation of phytobezoar, masses of indigestible plant material that may cause severe obstructions. Bezoars are responsible for 0.4–4 % of cases of gastric outlet obstruction. Although rare, these obstructions can result in symptoms like nausea, vomiting, and abdominal pain, and may require surgical intervention. In the absence of treatment, lodged bezoars in the gastrointestinal tract have been associated with mortality rates as high as 30 %. This case report presents a 59-year-old woman with a history of poorly controlled hypertension, whose blood pressure remained high at 180/100 mmHg despite increased doses of antihypertensive medication. In an attempt to manage her condition, she ingested a large garlic clove, unchewed, as a dietary supplement. She subsequently presented to the emergency department with two days of epigastric pain, persistent nausea, and vomiting after eating. Imaging, including an unenhanced CT scan, revealed a fluid-filled stomach with a 2 cm irregular dense mass at the gastric pylorus, suggesting a phytobezoar. Gastroscopy confirmed the presence of a large, undigested garlic clove in the pre-pyloric region, which was successfully removed using a Roth net. The pyloric area showed signs of mild inflammation, with the diameter of the pyloric channel smaller than the garlic clove. The patient was discharged in stable condition. This case highlights the potential gastrointestinal risks of consumption of unchewed foods, such as a garlic clove, and emphasizes the importance of careful dietary management in patients with hypertension.