Chewing of mixed betel leaves with areca nut and slaked lime (local name: “Doma Paani”) is a socially and culturally accepted common habit among Bhutanese as is in the other South East Asian countries. Intestinal obstruction due to a phytobezoar, resulting from the accumulation of betel quid, is unknown. We present a typical case of small intestinal obstruction due to phytobezoar in a 55-year-old Bhutanese woman, who had been chewing Doma Paani for a long duration. This case report highlights the importance of suspecting intestinal obstruction due to phytobezoar among betel leaves and areca nut chewers, presenting with the features of intestinal obstruction, and the importance of intervention in the form of cessation of chewing betel quid to prevent possible recurrent obstruction and malignancies such as oral and stomach cancers.

Keywords: Betel leaf; Phytobezoar; Intestinal obstruction