An unusual case of high intestinal obstruction is presented. This obstruction resulted form impaction of a phytobezoar at the level of a congenital ileal mucosal septum, a type-I intestinal atresia. Patients with this condition have a patent intestine and may reach adulthood with symptoms occurring only when an impaction develops. The preoperative diagnosis in such cases is difficult and the lesion may be missed even at laparotomy. In evaluating the cause of an otherwise unexplained intestinal obstruction, one should consider the possiblity of an intraluminal mucosal defect. Treatment consists of identifying the level of obstruction with segmental resection of the bowel including the mucosal defect, evacuation of the obstructing content and complete evaluation of the patency of the rest of the intestine.

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