Dr. Ajeet Kumar
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have been experiencing a low WBC count for many years. My constipation started about three years ago when with the help of fiber (Psyllium Husk) to flush out my hard stool. Constipation has gotten progressively worse over the last few months. Presently can only pass after taken Magnesium Oxide.
A recent CT scan with IV contrast might not highlight small bowel blockage (bezoar). I am seeking a review of these images for any conclusiveness of any small bowel abnormalities. I have attached the images. Kindly give your opinion.
Hi,
Welcome to icliniq.com.
Unfortunately, the images file which you uploaded is corrupted and can not be opened. You need to upload it again. And please upload the report of the CT (computed tomography) scan as well since the images and their magnification maybe not suitable to comment on the diagnosis. The radiologist even reporting which looking at the CT scan images on console and on full magnification.
You mentioned bezoar in the small bowel. Have you had a prior history of ingestion of undigestable matter? And do you have abdominal pain with constipation? What about your daily water and fiber intake?
Please answer the above questions so that I can help accordingly.
Patient's Query
Hi doctor,
Thank you.
The hospital gave me CT scan CD. Please advise how you can review the CD images or which files from the CD that I can send you. I am attaching the CT scan file.
With regard to bezoar, I have had no history of it. But it became clear that Psyllium seed powder taken without food could form hard balls in my small bowel. A recent colonoscopy reveals nothing abnormal in the colon. Kindly guide me.
Hello,
Welcome back to icliniq.com.
On CT scan (attachments removed to protect the patient's identity), there is no gross pathology (problem) in your small bowel. The large bowel (colon), however, shows fecal loading. The stools are present only, and this is otherwise a normal finding. I could not appreciate bezoar in your small bowel.
Now your primary concern of progressing constipation can be a functional thing. Meaning, the large bowel is somewhat working slow, and it can occur without any specific disease or reason.
Taking fiber does not cause bezoar formation. I do not think that it is a reason for your worsening constipation. In fact, the lack of fiber intake can worsen your constipation. So my advice is to start fiber supplements and take plenty of water in a day, such as eight glasses of water or even more.
Please let me know if you have any concerns. I suggest you upload the CT scan report from the radiologist as well, this would further confirm my findings, and this will ensure we are on the right track.
I hope this was helpful.
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Medical Gastroenterology
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