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Albostani A, Kfelati F, Alsaadi W, Faraman RA, Farman A. Small bowel obstruction due to a meat bolus bezoar: the second case report in literature. Ann Med Surg (Lond) 2024; 86:1139-1143. [PMID: 38333246 PMCID: PMC10849409 DOI: 10.1097/ms9.0000000000001633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Small bowel obstruction is a difficult emergency condition that may be caused due to many factors. However, bezoar-induced small bowel obstruction accounts for only 0.4-4.8% of all intestinal impaction patients. Bezoars are an entity of undigested materials classified into four types: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar. Meat bolus bezoar is not named under any of these classifications. Case presentation A 75-year-old man presented with abdominal distention, vomiting, and constipation. On radiological imaging, a mass in the terminal ileum was detected. After 2 days of ineffective conservative therapy, the authors decided to perform an open surgery. Enterotomy approach was chosen after failing to milk the object into the colons. The foreign body impacting the bowels was identified as a meat bolus bezoar. The patient improved after the surgery. The authors recorded no recurrence or complications with our patient after 18 months of follow-up. Discussion Patients with small bowel obstruction usually present with acute abdominal pain and distension despite the blockage cause. Computed tomography is the most effective diagnostic tool in such cases. In bezoar-induced intestinal blockage, surgical management is mandatory if conservative therapy fails. Conclusion It is important to consider bezoar-induced small bowel obstruction as a potential cause of impaction in cases of acute abdominal pain accompanied with risk factors of bezoar formation, despite the bezoar type.
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Affiliation(s)
| | - Fadi Kfelati
- University of Aleppo, Faculty of Medicine, Aleppo
| | | | | | - Aasem Farman
- General Surgery Department, Al-Mouwassat University Hospital, Damascus University, Damascus, Syria
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Yadav KK, Ghimire R, Subedi S, Kandel K, Yadav RK, Ghimire B, Shah JK. Radiolucent foreign body leading to complete small bowel obstruction: a diagnostic dilemma - a case report. Ann Med Surg (Lond) 2023; 85:6144-6147. [PMID: 38098606 PMCID: PMC10718328 DOI: 10.1097/ms9.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/12/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance Foreign body ingestion leading to luminal obstruction in both the small and large bowels is rare, especially in children. The authors present a case of a 7-year-old patient who presented with a small bowel obstruction caused by an ingested radiolucent foreign body. The previous herniotomy surgery 1 year back led to initial diagnostic confusion, highlighting the need for a broad differential diagnosis. Case presentation A 7-year-old child with a history of herniotomy presented with symptoms of small bowel obstruction. Radiological imaging revealed a soft tissue mass mimicking a polyp or cystic lesion. During exploratory laparotomy, a cystic structure was discovered in the terminal ileum. The foreign body, identified as a fluid-filled balloon, was inaccessible to endoscopy and was gently maneuvered into the ascending colon. It was punctured and removed during on-table colonoscopy. Clinical discussion This case underscores the challenges of diagnosing and managing luminal obstruction caused by radiolucent foreign bodies in children. The presence of previous surgery can mislead clinicians, necessitating a broad differential diagnosis. Radiological imaging played a crucial role in identifying the foreign body. Surgical intervention guided by an on-table colonoscopy allowed successful removal. Conclusion Foreign body ingestion leading to luminal obstruction should be considered, even in cases with previous abdominal surgery. Radiological imaging aids in identification, and timely surgical intervention, guided by on-table colonoscopy, facilitates foreign body removal. Awareness of such cases is essential for optimal care in pediatric patients with luminal obstruction caused by foreign body ingestion.
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Affiliation(s)
- Krishna K. Yadav
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Ranjeet Ghimire
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
| | - Sudan Subedi
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Krishna Kandel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
| | | | - Bikal Ghimire
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Jayant K. Shah
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
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Atthota S, MacDonald A, Ali A, Witkowski E, Dageforde LA. Bezoar at Jejunojejunostomy Following Liver Transplant: A Case Report. EXP CLIN TRANSPLANT 2023; 21:615-618. [PMID: 37584542 DOI: 10.6002/ect.2023.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
During pediatric liver transplant, biliary reconstruction is often performed using Roux-en-Y choledoc-hojejunostomy or hepaticojejunostomy due to size mismatch, excessive tension caused by distance between donor and recipient ducts, or for transplant to treat primary biliary pathology. This method can be associated with additional small bowel-related complications compared with end-to-end ductal anastomosis. We report a case of late small bowel obstruction secondary to an impacted bezoar that formed at a patulous jejunojejunostomy portion of the biliary-enteric anastomosis. The patient was a 26-year-old male patient, who underwent deceased donor whole liver transplant for pediatric acute liver failure. Prior to his presentation to our institution with 2 days of abdominal pain, nausea, persistent burping, and intermittent vomiting, the patient reported an uneventful posttransplant course and was followed up at the institution where his transplant was performed. There were no reported changes in diet or lifestyle and no similar episodes during his follow-up. The patient was managed surgically after a brief trial of nonoperative management. At laparotomy, the anastomosis was resected and reconstructed to improve enteric drainage and prevent recurrent bezoar formation. The patient was discharged with no postoperative complications and remained asymptomatic at 11 months follow-up. We describe the clinical course and our technical approach at initial choledochojejunostomy creation and at jejunojejunostomy revision.
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Affiliation(s)
- Srilakshmi Atthota
- From the Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kosmidis CS, Mystakidou CM, Varsamis N, Koulouris C, Sevva C, Papadopoulou K, Michael C, Katsios NI, Theodorou V, Miltiadous P, Papadopoulos K, Vlassopoulos K, Zarampouka K, Mantalovas S. Phytobezoar-Induced Mechanical Ileus and Incipient Intussusception: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1227. [PMID: 37512039 PMCID: PMC10383327 DOI: 10.3390/medicina59071227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Phytobezoars constitute conglomerates of indigested plant fibers and are a rare cause of acute mechanical ileus. They exhibit an increased prevalence in the elderly population and people with specific predisposing conditions. Radiological imaging can often set a definitive diagnosis and dictate the optimal therapeutic approach, combined with the patient's clinical status. An 81-year-old male presented with deteriorating clinical symptoms of intestinal obstruction, and an exploratory laparotomy was performed following inconclusive radiological findings; multiple phytobezoars and incipient intussusception were revealed intraoperatively. A patient's medical history can often raise clinical suspicion of phytobezoars. However, a careful etiological investigation is imperative in all cases of mechanical ileus in advanced ages; early detection and dissolution of phytobezoars, when applicable, can reduce the need for surgical interventions.
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Affiliation(s)
- Christoforos S Kosmidis
- European Interbalkan Medical Center, 10 Asklipiou Street, 55535 Pylaia, Greece
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Chrysi Maria Mystakidou
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Nikolaos Varsamis
- European Interbalkan Medical Center, 10 Asklipiou Street, 55535 Pylaia, Greece
| | - Charilaos Koulouris
- European Interbalkan Medical Center, 10 Asklipiou Street, 55535 Pylaia, Greece
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Christina Sevva
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Konstantina Papadopoulou
- 1st Department of Internal Medicine, G. Papanikolaou General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Christina Michael
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Nikolaos Iason Katsios
- Medical School, Faculty of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Vasiliki Theodorou
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Petrina Miltiadous
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Konstantinos Papadopoulos
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Konstantinos Vlassopoulos
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Katerina Zarampouka
- Pathology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Stylianos Mantalovas
- 3rd Surgical Department, University General Hospital of Thessaloniki "AHEPA", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
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Muacevic A, Adler JR, Parbhu S, Naraynsingh V. Small Bowel Obstruction Caused by an Aggressive Weight Loss Diet in a Patient With No Predisposing Factors. Cureus 2022; 14:e32594. [PMID: 36654594 PMCID: PMC9840865 DOI: 10.7759/cureus.32594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Phytobezoars are a well-documented cause of small bowel obstruction. Previous reports include patients who have predisposing factors such as gastric surgery, diabetes mellitus, or poor dentition. Consequences of extreme dieting have also been reported, but a resultant phytobezoar and life-threatening bowel obstruction are rare. We present a case of phytobezoar solely due to a diet inordinately high in fiber.
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Aydin I, Sengul I, Sengul D. Phytobezoar: An Unusual Condition Leading to Small Bowel Obstruction. Cureus 2022; 14:e23885. [PMID: 35402121 PMCID: PMC8985846 DOI: 10.7759/cureus.23885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
Bezoar is described as a swallowed, extraneous, and indigestible mass located in the gastrointestinal system; it accounts for 0.4-4.0% of all cases of mechanical intestinal obstruction. Intestinal obstruction is the most frequent complication of bezoar formation. Apart from intestinal obstructions, bezoars may also exhibit clinical symptoms such as abdominal pain, nausea, vomiting, weight loss, upper gastrointestinal bleeding, and gastric perforation. However, a considerable number of cases tend to be asymptomatic. Of note, its clinical symptoms cannot be differentiated easily from intestinal obstructions caused by other factors. As such, preoperative CT examination can provide invaluable information about the level of obstruction, etiology, and the existence of additional pathology and thereby help plan the type of surgical procedure required. If prompt diagnosis and timely treatment are not carried out, the condition may lead to significant morbidity and mortality.
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7
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Yang S, Cho MJ. Clinical Characteristics and Treatment Outcomes Among Patients With Gastrointestinal Phytobezoars: A Single-Institution Retrospective Cohort Study in Korea. Front Surg 2021; 8:691860. [PMID: 34250009 PMCID: PMC8263911 DOI: 10.3389/fsurg.2021.691860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: To describe our experience with phytobezoars, evaluate risk factors on treatment, and analyze whether previous gastric surgery affects treatment outcomes. Methods: Medical records of 51 patients with phytobezoars between 2000 and 2019 were retrospectively evaluated. We compared endoscopic and surgical treatment groups and evaluated risk factors using multivariate logistic regression analysis. And we compared patients with and without previous gastric surgery in the surgical treatment group. Results: The median patient age was 62.9 (range: 27–89) years. The endoscopic and surgical treatment groups included 26 (51%) and 25 (49%) patients, respectively. Patients aged ≥65 years, diabetes, and small intestinal phytobezoars were more frequent in the surgical treatment group. Previous gastric surgery (n = 16, 31.4%) was the most common predisposing risk factor, but without a significant difference between the groups. Enterotomy was performed for 20 patients (80%), segmental resection was performed for five patients (20%). Five patients (20%) had postoperative complications; there was one death. There were no significant differences in age, preoperative diagnosis, operation method, operative time, or postoperative stay between patients with and without previous gastric surgery, but postoperative complications were significantly more common in patients with previous gastric surgery. Conclusions: Phytobezoar should be suspected early in patients with previous gastric surgery or a specific food intake history. Early diagnosis and treatment are important for avoiding surgical intervention and complications, especially in elderly patients. Surgery is required in most patients with small intestinal phytobezoars, safe removal can be achieved mainly via enterotomy.
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Affiliation(s)
- Songsoo Yang
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Min Jeng Cho
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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8
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Wang S, Yang X, Zheng Y, Wu Y. Clinical characteristics and indications for surgery for bezoar-induced small bowel obstruction. J Int Med Res 2021; 49:300060520979377. [PMID: 33445996 PMCID: PMC8162205 DOI: 10.1177/0300060520979377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the clinical characteristics and indications for surgery for
bezoar-induced small bowel obstruction (BI-SBO). Methods Forty patients with BI-SBO were treated at our hospital from January 2017 to
December 2019, and these patients’ clinical and computed tomography (CT)
data were analyzed. Results Twenty-seven and 13 BI-SBO patients constituted the non-ST group and ST
group, respectively. The clinical manifestations of BI-SBO in both groups
were abdominal pain, nausea, vomiting, and lack of defecation. Comparing the
non-ST vs ST groups, respectively: mean age (years): 63.15 ± 16.15 vs
60.38 ± 12.47; duration of symptoms (hours): 55.11 ± 44.08 vs 59.33 ± 72.90;
mean bezoar length (cm): 5.31 ± 0.74 vs 3.72 ± 0.53; mean bezoar width (cm):
3.74 ± 0.48 vs 2.9 ± 0.64; bezoar CT maximum Hounsfield units (HU):
97.23 ± 12.36 vs 21.11 ± 7.27; total hospital stay (days): 5.56 ± 4.23 vs
7.12 ± 6.12 (mean: 8.62 ± 2.81); and total hospitalization costs (RMB):
6378.02 ± 3015.68 vs 8213.71 ± 5564.29. Mean operation time was 85.00 ± 8.90
minutes, and mean operation blood loss was 32.31 ± 19.64 mL. Bezoars were
located 60 to 160 cm from the ileocecal junction. Univariate analysis
demonstrated that bezoar length and width and maximum CT value were
significant risk factors for surgery. Conclusion Large bezoar size and high CT values may be indications for surgery. Surgery
is necessary and effective when nonsurgical treatment is ineffective.
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Affiliation(s)
- Shuai Wang
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Xiaohui Yang
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Yixiong Zheng
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
| | - Yulian Wu
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, Peoples Republic of China
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9
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Hassan Y, Ahmad F. Bezoar: An unusual cause of acute surgical abdomen. HAMDAN MEDICAL JOURNAL 2021. [DOI: 10.4103/hmj.hmj_45_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wei KY, Sung CC, Lin SH. Phytobezoar-induced small bowel obstruction in an elderly patient undergoing dialysis: a case report. J Int Med Res 2020; 48:300060520962942. [PMID: 33103517 PMCID: PMC7645422 DOI: 10.1177/0300060520962942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A phytobezoar is defined as an accumulation of poorly digested fruit and vegetable fibers in the gastrointestinal tract. Phytobezoar-induced small bowel obstruction is an uncommon entity and is usually removed surgically. We herein describe an elderly man undergoing dialysis who developed a phytobezoar because of excessive consumption of high-fiber fruits and inappropriate chewing. His potential predisposing factors were dialysis-related lifestyle changes, reduced activity levels, fluid restriction, and gastrointestinal motility dysfunction; however, he had no history of gastric surgery. The patient’s clinical history and characteristic imaging features aided in the diagnosis. He underwent medical treatment, and his recovery was uneventful. This case highlights the importance of an awareness of phytobezoar-induced small bowel obstruction in patients at increased risk of developing bezoars and demonstrates that this condition can occur in the absence of previous gastric surgery. We believe that elderly patients undergoing dialysis are at increased risk of developing bezoars. Excessive consumption of a strictly fibrous diet and insufficient chewing exacerbate the risk. A detailed dietary history and imaging features can aid in early diagnosis, leading to appropriate medical or surgical care. Surgical treatment is not inevitable in all cases. Individualized dietary suggestions in these patients are important for effective preventive control.
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Affiliation(s)
- Kuang-Yu Wei
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chien Sung
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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11
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Sarofim M, Joseph C, Tsang CLN, Lim CSH, Jaber M. Bezoar due to laxatives: a rare cause of acute small bowel obstruction. ANZ J Surg 2019; 90:1776-1777. [PMID: 31840912 DOI: 10.1111/ans.15621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Mina Sarofim
- Department of General Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Christo Joseph
- Department of General Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Chi L N Tsang
- Department of General Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Christopher S H Lim
- Department of General Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Mouhannad Jaber
- Department of General Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
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12
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Garcia DI, Taylor Head W, Lesher AP. Parsnip phytobezoar causing small bowel obstruction. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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13
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Manatakis D, Sioula M, Passas I, Zerbinis H, Dervenis C. Rectal seed bezoar due to sunflower seed: a case report and review of the literature. Pan Afr Med J 2019; 31:157. [PMID: 31065317 PMCID: PMC6488252 DOI: 10.11604/pamj.2018.31.157.12539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/22/2018] [Indexed: 12/21/2022] Open
Abstract
Seed bezoars are a subcategory of phytobezoars, caused by consumption of indigestible vegetable or fruit seeds. We present the case of a 64-year-old male patient, who presented at the Emergency Department, complaining of constipation, tenesmus and rectal pain. History and digital examination revealed a rectal seed bezoar due to sunflower seeds, impacted in the lower rectum. The patient underwent manual disimpaction under general anaesthesia, after conservative measures failed. Seed bezoars represent a different pathophysiological process compared to fibre bezoars. They are usually found in the rectum of patients without predisposing factors, causing constipation and anorectal pain. History taking and digital rectal examination are the cornerstones of diagnosis, with manual disimpaction under general anaesthesia being the procedure of choice.
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Affiliation(s)
- Dimitrios Manatakis
- Department of Surgery, Konstantopouleio General Hospital "Agia Olga", Nea Ionia, Athens, Greece
| | - Maria Sioula
- Department of Surgery, Konstantopouleio General Hospital "Agia Olga", Nea Ionia, Athens, Greece
| | - Ioannis Passas
- Department of Surgery, Konstantopouleio General Hospital "Agia Olga", Nea Ionia, Athens, Greece
| | - Helen Zerbinis
- Department of Surgery, Konstantopouleio General Hospital "Agia Olga", Nea Ionia, Athens, Greece
| | - Christos Dervenis
- Department of Surgery, Konstantopouleio General Hospital "Agia Olga", Nea Ionia, Athens, Greece
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14
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Li L, Xue B, Zhao Q, Xie HQ, Luan XR, Cui Q. Observation on the curative effect of long intestinal tube in the treatment of phytobezoar intestinal obstruction. Medicine (Baltimore) 2019; 98:e14861. [PMID: 30882686 PMCID: PMC6426573 DOI: 10.1097/md.0000000000014861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of the study was to observe the curative effect of long intestinal tube (LT) in the treatment of phytobezoar intestinal obstruction.We performed a retrospective study of patients with phytobezoar intestinal obstruction who underwent decompression with different tube insertion method. A total of 80 patients were collected and divided into nasogastric tube (NGT) group (n = 36) and LT group (n = 44) between August 2015 and August 2018 at our hospital. Univariate analysis was used to assess the clinical efficacy of 2 groups of patients.There were no significant differences in the mean age, sex ratio, and previous surgical history between the 2 groups. There were statistically significant differences between the 2 groups in terms of improvement time of clinical indications (4.2 ± 1.4 vs 2.5 ± 0.6 days; P = .008), liquid decompression amount on the first day of catheterization (870.4 ± 400.8 vs 1738.4 ± 460.2 mL; P = .000), transit operation rate (4/36 vs 0/44; P = .023), clinical cure rate (25/36 vs 40/44; P = .014), total treatment efficiency (32/36 vs 44/44; P = .023), and total hospitalization cost (3.25 ± 0.39 vs 2.07 ± 0.41 ¥ ten thousand; P = .000).The curative effect of LT in the treatment of phytobezoar intestinal obstruction is accurate and reliable, which can effectively improve the clinical symptoms of patients, comprehensively improve the non-surgical rate of intestinal obstruction treatment, reduce the total cost of hospitalization, and is worthy of promotion in clinical application.
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Affiliation(s)
- Liang Li
- Department of Gastrointestinal Surgery
| | - Bing Xue
- Department of Internal Medicine, Zibo Central Hospital of Shandong University, Zibo, Shandong, China
| | | | | | | | - Qing Cui
- Department of Gastrointestinal Surgery
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15
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Sugimoto S, Shimono T, Takeshita T, Yamamoto A, Shindo D, Miki Y. Clinical and CT findings of small bowel obstruction caused by rice cakes in comparison with bezoars. Jpn J Radiol 2019; 37:301-307. [PMID: 30649674 DOI: 10.1007/s11604-019-00811-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/10/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Rice cakes have not been recognized as a cause of small bowel obstruction (SBO) worldwide. We compared clinical and CT findings of rice cake SBO versus SBO due to bezoars, the most common cause of food-induced SBO. METHODS Twenty-four patients with rice cake SBO (n = 17) or bezoar SBO (n = 7) were retrospectively evaluated for clinical findings and the following multi-detector CT (MDCT) features: identification of the transition zone, presence of intraluminal lesions, degree of obstruction, and length and attenuation of obstructing materials. Categorical variables were compared by Fisher's exact test, and continuous variables by independent t test. RESULTS None of the rice cake SBO patients required surgery, whereas 4/7 (57%) bezoar SBO patients underwent surgery. On MDCT, rice cake residues were recognized as well-defined intraluminal lesions of shorter length (29.8 ± 4.6 mm vs. 47.7 ± 10.8 mm for bezoars; p < 0.0001) and higher attenuation (106 ± 27.8 HU vs. - 62.8 ± 14.7 HU for bezoars; p < 0.0001). CONCLUSIONS Rice cake SBO patients did not require surgery. On MDCT, rice cake residues were significantly shorter and higher in attenuation than bezoars. These findings facilitate diagnosis and support the conservative management of rice cake SBO.
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Affiliation(s)
- Shigehiro Sugimoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan.
| | - Taro Shimono
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Tohru Takeshita
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Daisuke Shindo
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Abeno-ku, Osaka, Osaka, 545-8585, Japan
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16
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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17
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Islam S, Saroop S, Bheem V, Harnarayan P, Naraynsingh V. Mango seed causing acute large bowel obstruction in descending colon-world's first reported case. Int J Surg Case Rep 2018; 51:125-129. [PMID: 30223197 PMCID: PMC6141636 DOI: 10.1016/j.ijscr.2018.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/27/2018] [Accepted: 08/12/2018] [Indexed: 11/10/2022] Open
Abstract
Phytobezoars are a rare cause of large bowel obstruction. It should be included in the differentials in patients with no specific symptoms and signs of colorectal cancers. Conservative and or Colonoscopic approach should be attempted first, in all patients with no signs of peritonitis. Patients who present in an acute setting with signs of peritonitis require laparotomy even when the diagnosis is a benign phytobezoar.
Introduction Phytobezoars are a very rare cause of large bowel obstruction. Mango seeds as a phytobezoar causing large bowel obstruction have not been reported in the English literature. Presentation of case We present the case of a 69 years old female who presented to us with clinical and radiological signs of acute large bowel obstruction. On laparotomy, it was noted that mango seeds as a phytobezoar was responsible for the obstruction in the descending colon. Discussion Phytobezoars are a rare but known cause of small bowel obstruction. Large bowel obstruction is even rarer. The literature has documented a few cases of small bowel obstruction caused by mango seeds but none for large bowel obstruction. The most frequent reported sites of large bowel obstruction are the sigmoid colon and recto-sigmoid junction. However, phytobezoar causing descending colonic obstruction without any pre-existing underlying pathology has not been reported. Conclusion The association of bezoar with acute large bowel obstruction is a very rare however; it must be entertained in the differential diagnosis of any large bowel obstruction. Early diagnosis and treatment can avoid lethal complications. Our case being the first case of mango seeds phytobezoar in descending colon with acute large bowel obstruction; signifies its importance for reporting in the English literature.
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Affiliation(s)
- Shariful Islam
- San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago; Department of Clinical Surgical Science, University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Sabrina Saroop
- San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago; Department of Clinical Surgical Science, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vinoo Bheem
- San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago
| | - Patrick Harnarayan
- San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago; Department of Clinical Surgical Science, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Science, University of the West Indies, St. Augustine, Trinidad and Tobago
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18
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Abstract
A bezoar is a mass of undigested, or partially digested, material forming in the lumen of the gastroenteric tract, causing occlusive or subocclusive events. The most frequent types of bezoars are those composed of vegetable fibers, also called phytobezoars, which, by virtue of their high content in cellulose, hemicellulose, and lignin, remain undigested in the stomach and intestines and, from there, can migrate and occlude the narrowest portions of the bowel. The areas that are most frequently affected by occlusive phenomena related to the presence of bezoars are the stomach and the small intestine, although colic localizations are extremely rare. In this article, we have studied the case of a fatal colic obstruction caused by a phytobezoar in an 84-year-old woman who was found dead at her home. The autopsy revealed that the cause of the obstruction was a large artichoke fragment occluding the central part of the descending colon. Additional histological examinations confirmed that the death was attributable to bowel obstruction resulting in acute peritonitis.
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19
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When a cure becomes the pathology: mechanical bowel obstruction due to herbal pharmacobezoar. A case report with review of literature. Clin J Gastroenterol 2018; 11:396-400. [PMID: 29680980 DOI: 10.1007/s12328-018-0861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/14/2018] [Indexed: 10/17/2022]
Abstract
Bezoars are intra-luminal concretions of ingested material which accumulate within the bowel. They are termed pharmacobezoars when the constituent material is drugs. We report a 64-year-old female with abdominal pain and obstipation for 3 days. Patient had completed anti-tuberculous combination therapy for suspected abdominal tuberculosis 25 years ago. She exhibited features of shock with a right iliac fossa lump. Abdominal X-ray displayed multiple air-fluid levels with densely cluttered radio-opacities in the right lower quadrant. Laparotomy revealed a palpable mid-ileal intra-luminal lump, adherent to the ascending colon and proximal ileum necessitating resection. Ex vivo examination of resected specimen revealed numerous tablets aggregating proximal to an ileal stricture. The patient post-operatively confirmed the tablets resembled the herbal laxatives she had been consuming. Pharmacobezoars can lead to subacute intestinal obstruction. Numerous drugs have been implicated. Patients with partial gastrectomy and vagotomy are at risk. CT is the pre-eminent diagnostic modality. The treatment options for pharmacobezoars include lavage, endoscopic retrieval, in addition to surgery. Pharmacobezoars need a high index of suspicion for pre-operative diagnosis. A detailed history and correlation with radioimaging can offer important cues. One can prevent pharmacobezoars by abstaining from unwarranted medications and identifying those at risk.
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20
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Yelisetti R, Awad A, Ambreen B, Zijoo R, Wallach S. Pharmacobezoar: An Unusual Cause of Large Bowel Obstruction. Gastroenterology Res 2017; 10:315-317. [PMID: 29118874 PMCID: PMC5667699 DOI: 10.14740/gr871w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022] Open
Abstract
Large bowel obstruction (LBO) is an abdominal emergency with high morbidity and mortality rates if left untreated. LBO is four to five times less frequent than small bowel obstruction (SBO) and the causes of LBO and SBO differ substantially. Colonic malignancy remains the most common cause of LBO (> 60%). Additional causes of LBO include entities such as diverticulitis, colonic volvulus, and adhesion. Herein we present a case of acute LBO caused by pharmacobezoar.
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Affiliation(s)
- Rishitha Yelisetti
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Areig Awad
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Bushra Ambreen
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Ritika Zijoo
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Sara Wallach
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
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21
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Fernando AR, Bulathsinghela R, Samarasekera DN. An unusual cause of small bowel obstruction due to an ingested mango seed: a case report. BMC Res Notes 2017; 10:549. [PMID: 29096699 PMCID: PMC5667479 DOI: 10.1186/s13104-017-2875-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 10/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background Intestinal obstruction can occur due to multiple aetiologies. Intestinal obstruction due to phytobezoar have been reported. However, intestinal obstruction due to a mango seed has not been reported. Therefore, accidental ingestion of a mango seed is rare, and for an ingested mango seed to cause intestinal obstruction is rarer. Case presentation This case report is of a male who accidentally ingested a mango seed and presented with intestinal obstruction. The obstruction was at the terminal ileum. It required laparotomy for retrieval. Conclusion It is extremely rare for a mango seed to cause intestinal obstruction. Hence, diagnosis requires a high degree of clinical suspicion. Instead of laparotomy, studies have demonstrated the use of laparoscopy for removal of ingested seeds.
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Affiliation(s)
- A R Fernando
- Professorial Surgical Unit, National Hospital of Sri Lanka, Colombo, 00700, Sri Lanka.
| | - R Bulathsinghela
- Professorial Surgical Unit, National Hospital of Sri Lanka, Colombo, 00700, Sri Lanka
| | - D N Samarasekera
- Professorial Surgical Unit, Faculty of Medicine, University of Colombo, Colombo, 00700, Sri Lanka
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22
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An Obstructing Small Bowel Phytobezoar in an Elderly Female Nigerian: A Case Report and Literature Review. Case Rep Surg 2017; 2017:6962876. [PMID: 28740743 PMCID: PMC5504942 DOI: 10.1155/2017/6962876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022] Open
Abstract
Small bowel obstruction secondary to phytobezoars is an unusual presentation in surgery. We present a case of an elderly female patient with an insidious onset of abdominal pain, abdominal distension, and bilious vomiting diagnosed radiologically to be small bowel obstruction. Exploratory laparotomy revealed a trapped mass of vegetable matter in the distal ileum. She had enterotomy with primary closure for removal of obstructing ileal phytobezoars. Her postoperative recovery was uneventful.
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23
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Hong IT, Cha JM, Ki HJ, Kwak MS, Yoon JY, Shin HP, Jeoun JW, Choi SI. Small Bowel Obstruction Caused by Aloe vera Bezoars: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 69:312-315. [PMID: 28539037 DOI: 10.4166/kjg.2017.69.5.312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Small bowel obstruction is a clinical condition commonly caused by postoperative adhesion, volvulus, intussusceptions, and hernia. Small bowel obstruction due to bezoars is clinically uncommon, accounting for approximately 2-4% of all obstructions. Computed tomography (CT) is a useful method in diagnosing the cause of small bowel obstruction. However, small bowel obstruction caused by bezoars may not be detected by an abdominal CT examination. Herein, we report a rare case of small bowel obstruction by Aloe vera bezoars, which were undetected by an abdominal CT. Phytobezoars should be included in the differential diagnosis of small bowel obstruction in patients with predisposing factors, such as excessive consumption of high-fiber food and diabetes.
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Affiliation(s)
- In Taik Hong
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hye Jin Ki
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Won Jeoun
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
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24
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Razavianzadeh N, Foroutan B, Honarvar F, Forozeshfard M. Small bowel obstruction attributable to phytobezoar. Oxf Med Case Reports 2016; 2016:omw092. [PMID: 28031856 PMCID: PMC5184834 DOI: 10.1093/omcr/omw092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/14/2016] [Accepted: 11/07/2016] [Indexed: 12/13/2022] Open
Abstract
Small bowel obstruction (SBO) is a common condition encountered in surgical practice. Literature shows divers and many different etiologies for intestinal obstruction. However, bezoars are rarely reported as an etiological factor. A bezoar happens most commonly in patients with impaired gastrointestinal motility. There are four types of bezoars: phytobezoars, trichobezoars, pharmacobezoars and lactobezoars. The most common type is phytobezoars, which are composed of undigested fiber from vegetables or fruits especially persimmons. They are mostly composed of cellulose, tannin and lignin. The commonest phytobezoar reported worldwide is related to the persimmon fruit ingestion. The most common symptom of bezoar-induced SBO is abdominal pain (96–100%). Other common symptoms include nausea and vomiting. Primary small bowel phytobezoars almost always present as SBO. We present an unusual case of SBO caused by a phytobezoar in a 35-year-old patient. Many types of bezoar can be removed endoscopically, but some will require operative intervention.
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Affiliation(s)
- Nasrin Razavianzadeh
- Department of Internal Medicine , School of Medical Sciences , Azad University , Shahroud , Iran
| | - Behzad Foroutan
- Department of Pharmacology , School of Medicine , Shahroud University of Medical Sciences , Shahroud , Iran
| | - Farhad Honarvar
- Department of Internal Medicine , School of Medical Sciences , Azad University , Shahroud , Iran
| | - Mohammad Forozeshfard
- Department of Radiology , School of Medicine , Semnan University of Medical Sciences , Semnan , Iran
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25
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Nasri B, Calin M, Shah A, Gilchrist B. A rare cause of small bowel obstruction due to bezoar in a virgin abdomen. Int J Surg Case Rep 2015; 19:144-6. [PMID: 26764889 PMCID: PMC4756184 DOI: 10.1016/j.ijscr.2015.12.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/20/2015] [Indexed: 12/11/2022] Open
Abstract
Bezoar-induced small bowel obstruction remains an uncommon diagnosis accounting for 0.4–4% of all mechanical bowel obstruction that poses a diagnostic and management challenge. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, poor dentition or a history suggestive of increased fiber intake, or patient with psychiatric disorders. The presence of well-defined intraluminal mass with mottled gas pattern on CT scan is suggestive of an intestinal bezoar.
Introduction Bezoar is an unusual cause of small bowel obstruction accounting for 0.4–4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum. Case report A 28-year-old male with no past surgical history, known to have severe mental retardation presented with anorexia. CT scan demonstrated dilated small bowel loops and intraluminal ileal mass with mottled appearance. At exploratory laparotomy, a bezoar was found impacted in the terminal ileum 5–6 inches away from the ileocecal valve and was removed through an enterotomy. Discussion Bezoars are concretions of fibers or foreign bodies in the alimentary tract. Small bowel obstruction is one of common clinical symptoms. The typical finding of well-defined intraluminal mass with mottled gas pattern in CT scan is suggestive of an intestinal bezoar. The treatment option of bezoar is surgery including manual fragmentation of bezoar and pushing it toward cecum, enterotomy or segmental bowel resection. Thorough exploration of abdominal cavity should be done to exclude the presence of concomitant bezoars. Recurrence is common unless underlying predisposing condition is corrected. Conclusions Bezoar-induced small bowel obstruction remains an uncommon diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, a history suggestive of increased fiber intake, or patient with psychiatric disorders. CT scan is helpful for preoperative diagnosis.
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Affiliation(s)
- Baongoc Nasri
- Department of Surgery, Bronx Lebanon Hospital, 1650 Grand Concourse, Bronx, NY 10457, USA.
| | - Marius Calin
- Department of Surgery, Bronx Lebanon Hospital, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Ajay Shah
- Department of Surgery, Bronx Lebanon Hospital, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Brian Gilchrist
- Department of Surgery, Bronx Lebanon Hospital, 1650 Grand Concourse, Bronx, NY 10457, USA
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26
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Castren E, Hakeem A, Mahmood NS, Aryal K. Two cases of small bowel obstruction secondary to a swallowed potato. BMJ Case Rep 2015; 2015:bcr-2015-213744. [PMID: 26689254 DOI: 10.1136/bcr-2015-213744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bowel obstruction due to bezoars (compaction of ingested material within the gastrointestinal tract) is a rare, but well documented occurrence. In this paper, we present two cases of potato-induced small bowel obstruction. Both patients were approximately 50 years old and had cerebral palsy and learning disabilities, respectively. They presented with abdominal pain and bilious vomiting, with no medical or surgical history. Diagnosis of small bowel obstruction was confirmed by CT prior to taking the patients to the operating theatre, where whole potatoes were found to be obstructing each patient's bowel lumen. Both patients underwent laparotomy with enterotomy and removal of the potato. They both made a good recovery. Through a literature review of bezoar-induced bowel obstruction, these cases highlight important diagnostic and management principles.
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Affiliation(s)
- E Castren
- Department of General and Colorectal Surgery, James Paget University Hospital NHS Trust, Gorleston-on-Sea, UK
| | - A Hakeem
- Department of General and Colorectal Surgery, James Paget University Hospital NHS Trust, Gorleston-on-Sea, UK
| | - N S Mahmood
- Department of Radiology, James Paget University Hospital NHS Trust, Gorleston-on-Sea, UK
| | - K Aryal
- Department of General and Colorectal Surgery, James Paget University Hospital NHS Trust, Gorleston-on-Sea, UK
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27
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Abstract
Owing to their rare occurrence, persimmon bezoars are often overlooked as a cause of small bowel obstruction. We herein report a small bowel obstruction in a 67-year-old Japanese female who regularly consumed persimmons in autumn. The patient presented to our hospital with typical complaints of abdominal distension with pain for 2 days. Based on the patient's history of a cesarean section 34 years ago, we initially diagnosed her with small bowel obstruction resulting from adhesions and placed an ileus tube. At first, the patient rejected the operation in spite of our recommendation. After 10 days, because the ileus tube was unable to relieve the obstruction, finally surgery was scheduled. Upon releasing the obstruction by partial resection of the small bowel, we found an impacted bezoar without any evidence of adhesions. After stone analysis, we first realized her regular persimmon intake. This case serves as an important reminder to obtain dietary history in order to investigate all possible causes of small bowel obstruction when intestinal obstruction is suspected.
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28
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Dikicier E, Altintoprak F, Ozkan OV, Yagmurkaya O, Uzunoglu MY. Intestinal obstruction due to phytobezoars: An update. World J Clin Cases 2015; 3:721-726. [PMID: 26301232 PMCID: PMC4539411 DOI: 10.12998/wjcc.v3.i8.721] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/02/2015] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
The term bezoar refers to an intraluminal mass in the gastrointestinal system caused by the accumulation of indigestible ingested materials, such as vegetables, fruits, and hair. Bezoars are responsible for 0.4%-4% of cases of mechanical intestinal obstruction. The clinical findings of bezoar-induced ileus do not differ from those of mechanical intestinal obstruction due to other causes. The appearance and localization of bezoars can be established with various imaging methods. Treatment of choice depends on the localization of the bezoar which makes the clinical findings.
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29
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Law GW, Lin D, Thomas R. Colonic phytobezoar as a rare cause of large bowel obstruction. BMJ Case Rep 2015; 2015:bcr-2014-208493. [PMID: 25858930 DOI: 10.1136/bcr-2014-208493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bezoars are masses formed by the concretion of stomach contents or debris within the gastrointestinal tract. Bezoars are rare and account for only 0.4-4% of all cases of gastrointestinal obstruction and mainly occur in the stomach or small intestine. Intestinal obstruction caused by colonic bezoars is extremely rare. We report a case of a distal sigmoid obstruction caused by a phytobezoar in a 60-year-old man with no obvious precipitating causes. He presented to the emergency department acutely unwell and a subsequent abdominal CT scan showed a mass within the proximal sigmoid colon suspicious for a bezoar. He proceeded to have an urgent laparotomy and the obstructive intraluminal mass in the sigmoid colon was identified and manually broken down. Subsequent histopathological assessment reported amorphous material and plant cellular matter consistent with the diagnosis of a phytobezoar.
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Affiliation(s)
- Gin Way Law
- Division of Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Diwei Lin
- Division of Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Rebecca Thomas
- Division of Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
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30
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A non-occlusive bezoar of caecum in a 7-year-old child: ultrasound detection and multimodality imaging management. J Ultrasound 2015; 19:223-6. [PMID: 27635158 DOI: 10.1007/s40477-015-0165-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/06/2015] [Indexed: 10/23/2022] Open
Abstract
Bezoars represent the most frequent foreign bodies of gastro-intestinal system, involving first of all the stomach and small intestine; instead the cecum tract is a very uncommon site for bezoars associated with a poor abdominal symptomatology. We report a case of a very rare localization of bezoar in the caecum tract of the ascending colon in a child affected by undefined abdominal pain. In this case, the abdominal Ultrasound examination showed characteristic imaging findings of bezoar completely comparable to that of Computed Tomography, allowing an early diagnosis of bezoar and the possibility of a conservative treatment for the young patient.
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31
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Manning EP, Vattipallly V, Niazi M, Shah A. PhytobezoarInduced Small Bowel Obstruction in a Young Male with Virgin Abdomen. ACTA ACUST UNITED AC 2015; 5. [PMID: 29795770 PMCID: PMC5962263 DOI: 10.4172/2161-069x.1000266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Phytobezoars are a rare cause of small bowel obstruction. Such cases are most commonly associated with previous abdominal surgery or poor dentition or psychiatric conditions. A 40 year old man with a virgin abdomen and excellent dentition and no underlying psychiatric condition presented with an acute abdomen. CT scan revealed a transition point between dilated proximal loops of small bowel and collapsed distal loops. Exploratory laparotomy revealed a phytobezoar unable to be milked into the cecum and an enterectomy with primary anastamosis was performed without complication. A detailed history revealing several less common predisposing factors for phytobezoars should increase clinical suspicion of a phytobezoarinduced small bowel obstruction in the setting of an acute abdomen. Vigilance in presentations of an acute abdomen improves the usefulness of medical imaging, such as a CT, to detect phytobezoars. Understanding mechanisms of phytobezoar formation helps guide management and may prevent surgery.
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Affiliation(s)
- Edward P Manning
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Masooma Niazi
- Department of Pathology, Bronx Lebanon Hospital, Bronx, NY, USA
| | - Ajay Shah
- Department of Surgery, Bronx Lebanon Hospital, Bronx, NY, USA
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32
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Qin B, Wan XL, Guo XY, Dong L. Successful endoscopic treatment of an intestinal diospyrobezoar migrated from the stomach. BMJ Case Rep 2014; 2014:bcr-2014-204966. [PMID: 25100813 DOI: 10.1136/bcr-2014-204966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diospyrobezoars are a rare cause of small intestinal obstruction. A 78-year-old man, with a history of persimmons ingestion and gastrectomy, presented with upper abdominal pain and weight loss. The upper gastrointestinal endoscopy showed a huge bezoar in the stomach. After initial endoscopic fragmentation, the abdominal X-ray revealed intestinal obstruction and the colonoscopy showed large fragments of the bezoar filling the terminal ileum. The migrated bezoar pieces were successfully removed by endoscopic fragmentation with a cutting lithotripter.
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Affiliation(s)
- Bin Qin
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiao Long Wan
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiao Yan Guo
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Dong
- Department of Gastroenterology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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33
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El Boussaadni Y, El Mahjoubi S, El Ouali A, Khannoussi W, Benajiba N. [A rare cause of dysphagia in children: the bezoar]. Pan Afr Med J 2014; 18:109. [PMID: 25404969 PMCID: PMC4232174 DOI: 10.11604/pamj.2014.18.109.4426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/02/2014] [Indexed: 11/11/2022] Open
Abstract
La dysphagie est un signe sémiologique peu fréquent chez l'enfant, dont l'oesophagite est souvent la cause. Les auteurs rapportent une cause rare de dysphagie chez une enfant de 3 ans et demi, ayant évolué 5 mois avant son admission et chez qui l'exploration para clinique a conclu à un bézoard. L'endoscopie a permis une extraction totale. À travers ce cas, nous essayons de rappeler aux praticiens les particularités cliniques de cette affection, ainsi que celles de la prise en charge et le suivi.
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Affiliation(s)
- Yousra El Boussaadni
- Université Mohamed Premier, CHU Mohamed VI, Département de Pédiatrie, Hopital Al Farabi, Oujda, Maroc
| | - Sahare El Mahjoubi
- Université Mohamed Premier, CHU Mohamed VI, Département de Gastroenterologie, Hopital Al Farabi, Oujda, Maroc
| | - Aziza El Ouali
- Université Mohamed Premier, CHU Mohamed VI, Département de Pédiatrie, Hopital Al Farabi, Oujda, Maroc
| | - Wafaa Khannoussi
- Université Mohamed Premier, CHU Mohamed VI, Département de Gastroenterologie, Hopital Al Farabi, Oujda, Maroc
| | - Noufissa Benajiba
- Université Mohamed Premier, CHU Mohamed VI, Département de Pédiatrie, Hopital Al Farabi, Oujda, Maroc
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Bingham JR, Causey MW, Haque MI. Phytobezoar within Meckel's Diverticulum: An Unusual Cause of Intestinal Obstruction. Am Surg 2014. [DOI: 10.1177/000313481408000311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jason Ray Bingham
- General Surgery Department Madigan Army Medical Center Tacoma, Washington
| | | | - Mohamad Imad Haque
- General Surgery Department Madigan Army Medical Center Tacoma, Washington
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Park SE, Ahn JY, Jung HY, Na S, Park SJ, Lim H, Choi KS, Lee JH, Kim DH, Choi KD, Song HJ, Lee GH, Kim JH. Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver 2014; 8:400-7. [PMID: 25071905 PMCID: PMC4113045 DOI: 10.5009/gnl.2014.8.4.400] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/09/2013] [Accepted: 07/22/2013] [Indexed: 12/16/2022] Open
Abstract
Background/Aims With technical and instrumental advances, the endoscopic removal of bezoars is now more common than conventional surgical removal. We investigated the clinical outcomes in a patient cohort with gastrointestinal bezoars removed using different treatment modalities. Methods Between June 1989 and March 2012, 93 patients with gastrointestinal bezoars underwent endoscopic or surgical procedures at the Asan Medical Center. These patients were divided into endoscopic (n=39) and surgical (n=54) treatment groups in accordance with the initial treatment modality. The clinical feature and outcomes of these two groups were analyzed retrospectively. Results The median follow-up period was 13 months (interquartile range [IQR], 0 to 77 months) in 93 patients with a median age of 60 years (IQR, 50 to 73 years). Among the initial symptoms, abdominal pain was the most common chief complaint (72.1%). The bezoars were commonly located in the stomach (82.1%) in the endoscopic treatment group and in the small bowel (66.7%) in the surgical treatment group. The success rates of endoscopic and surgical treatment were 89.7% and 98.1%, and the complication rates were 12.8% and 33.3%, respectively. Conclusions Endoscopic removal of a gastrointestinal bezoar is an effective treatment modality; however, surgical removal is needed in some cases.
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Affiliation(s)
- So-Eun Park
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Na
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Jeong Park
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Lim
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwi-Sook Choi
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Kim
- Department of Gastroenterology and Asan Digestive Disease Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Pujar K A, Pai A S, Hiremath V B. Phytobezoar: a rare cause of small bowel obstruction. J Clin Diagn Res 2013; 7:2298-9. [PMID: 24298509 DOI: 10.7860/jcdr/2013/7248.3504] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/23/2013] [Indexed: 12/11/2022]
Abstract
Phytobezoar is an unusual cause of small bowel obstruction. It accounts for about 0.4%-4% of all mechanical bowel obstruction. However, the symptoms are not very different from those caused by usual aetiologies of small bowel obstruction. The commonest site of obstruction is terminal ileum. Treatment of small bowel obstruction due to Phytobezoar is surgery. Prevention includes avoidance of high fibre diet, prokinetics particularly in patients who have undergone gastric surgery. A 57-year-old male presented with symptoms and signs of small bowel obstruction. On exploratory laparotomy Phytobezoar in the ileum was found to be the cause of obstruction. Diagnosis was confirmed by histopathology.
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Affiliation(s)
- Anupama Pujar K
- Assistant Professor, Department of Surgery, M.S. Ramaiah Medical College , Bangalore, India
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CT findings of patients with small bowel obstruction due to bezoar: a descriptive study. ScientificWorldJournal 2013; 2013:298392. [PMID: 23690741 PMCID: PMC3654257 DOI: 10.1155/2013/298392] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/01/2013] [Indexed: 12/16/2022] Open
Abstract
Purpose. The aim of this study was to present the computed tomography (CT) findings of bezoars that cause obstruction in the small bowel and to emphasize that some CT findings can be considered specific to some bezoar types.
Materials and Methods. The records of 39 patients who underwent preoperative abdominal CT and subsequent operation with a diagnosis of intestinal obstruction due to bezoars were retrospectively analyzed. Results. In total, 56 bezoars were surgically removed from 39 patients. Bezoars were most commonly located in the jejunum (n = 26/56, 46.4%). Sixteen (41.0%) patients had multiple bezoar locations in the gastrointestinal tract. Common CT findings in all patients were a mottled gas pattern and a focal ovoid or round intraluminal mass with regular margins and a heterogeneous internal structure. Furthermore, some CT findings were determined to be specific to bezoars caused by persimmons. Conclusions. Preoperative CT is valuable in patients admitted with signs of intestinal obstruction in geographic regions with a high bezoar prevalence. We believe that the correct diagnosis of bezoars and the identification of their number and location provide a great advantage for all physicians and surgeons. In addition, some types of bezoars have unique CT findings, and we believe that these findings may help to establish a diagnosis.
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Salemis NS, Panagiotopoulos N, Sdoukos N, Niakas E. Acute Surgical Abdomen Due to Phytobezoar-induced Ileal Obstruction. J Emerg Med 2013; 44:e21-3. [DOI: 10.1016/j.jemermed.2011.06.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 05/01/2011] [Accepted: 06/05/2011] [Indexed: 01/08/2023]
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Altintoprak F, Dikicier E, Deveci U, Cakmak G, Yalkin O, Yucel M, Akbulut G, Dilek ON. Intestinal obstruction due to bezoars: a retrospective clinical study. Eur J Trauma Emerg Surg 2012; 38:569-75. [PMID: 26816260 DOI: 10.1007/s00068-012-0203-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/07/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to compare the results of surgical procedures applied to rare intestinal obstruction cases due to bezoars and to identify effective factors for determining the type of surgical procedure to be applied. METHODS The records of 62 patients who had received gastrointestinal surgical treatment due to bezoars were assessed retrospectively. The preoperative characteristics, perioperative findings and postoperative results of cases that had and had not undergone an enterotomy were compared RESULTS The average patient age was 57.7 years (range, 26-84 years), and all patients had phytobezoars, except one. The most common location for bezoars was the jejunum (28 cases, 45.1 %). Sixteen cases (25.8 %) had multiple bezoars located in different parts of the gastrointestinal tract. While milking was applied to 26 cases (41.9 %) with small intestinal bezoars, an enterotomy was used to remove bezoars in 23 cases (37 %). More complications tended to be identified in patients who underwent an enterotomy; however, the difference was not significant (p = 0.553). CONCLUSIONS The frequency of previous abdominal surgery in patients suffering from an intestinal obstruction due to bezoars causes diagnostic conflict. The location of bezoars in the small intestine should also be considered when deciding the surgical procedure, as well as the physical properties of the bezoars. Our opinion is that conducting the milking procedure should not be insisted on, and that an enterotomy should be conducted when necessary.
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Affiliation(s)
- F Altintoprak
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey.
| | - E Dikicier
- Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - U Deveci
- Department of General Surgery, Maltepe University Faculty of Medicine, Istanbul, Turkey
| | - G Cakmak
- Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - O Yalkin
- Department of General Surgery, Sakarya University Research and Educational Hospital, Sakarya, Turkey
| | - M Yucel
- Department of Emergency Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - G Akbulut
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - O N Dilek
- Department of General Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
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40
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Affiliation(s)
- Prita H Mohanty
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY, USA.
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Ahn BK. Is abdominal computed tomography helpful for the management of an intestinal obstruction caused by a bezoar? JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:69-70. [PMID: 22606643 PMCID: PMC3349811 DOI: 10.3393/jksc.2012.28.2.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Byung-Kwon Ahn
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
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Oh SH, Namgung H, Park MH, Park DG. Bezoar-induced Small Bowel Obstruction. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:89-93. [PMID: 22606648 PMCID: PMC3349816 DOI: 10.3393/jksc.2012.28.2.89] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 11/10/2011] [Accepted: 11/20/2011] [Indexed: 12/22/2022]
Abstract
Purpose The aim of this study was to observe the clinical features of a bezoar-induced small bowel obstruction and to investigate the role of abdominal computed tomography (CT) in establishing the diagnosis. Methods We retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010. Results Thirteen patients (65%) had a history of abdominal surgery. Nine patients (45%) were diagnosed with a bezoar before surgery, seven patients were diagnosed by using abdominal CT, and two patients were diagnosed with a small bowel series. Abdominal CT was performed in 15 patients, and the diagnostic accuracy was 47% (7/15). Surgery revealed ten bezoars in the jejunum and 11 in the ileum. Two patients had bezoars found concurrently in the stomach. Spontaneous removal took place in two patients. An enterotomy and bezoar extraction was performed in 15 patients. Fragmentation and milking, a small bowel resection, and a Meckel's diverticulectomy were performed in one patient each. Early operative treatment was possible (P = 0.036) once the bezoar had been diagnosed by using abdominal CT. There tended to be fewer postoperative complications in patients who were diagnosed with a bezoar by using abdominal CT, but the result was not statistically significant (P = 0.712). Conclusion A preoperative diagnosis of bezoar-induced small bowel obstruction by using clinical features was difficult. Increased use of abdominal CT led to a more accurate diagnosis and to earlier surgery for bezoar-induced small bowel obstructions, thereby reducing the rate of complications.
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Affiliation(s)
- Se Heon Oh
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
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Kement M, Ozlem N, Colak E, Kesmer S, Gezen C, Vural S. Synergistic effect of multiple predisposing risk factors on the development of bezoars. World J Gastroenterol 2012; 18:960-4. [PMID: 22408356 PMCID: PMC3297056 DOI: 10.3748/wjg.v18.i9.960] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/25/2011] [Accepted: 01/07/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the clinical characteristics of patients with gastric or intestinal bezoars recently treated in our hospital.
METHODS: In this study, a retrospective chart review of consecutive patients with gastrointestinal bezoars, who were treated at the Samsun Education and Research Hospital between January 2006 and March 2011, was conducted. Data on demographic characteristics, clinical presentation, history of risk factors, diagnostic procedures, localization of bezoars, treatment interventions, and postoperative morbidity and mortality rates were collected and evaluated.
RESULTS: Forty-two patients [26 (61.9%) males and 16 (31.1%) females] with a mean ± SD (range) age of 55.8 ± 10.5 (37-74) years were enrolled in this study. Thirty-six patients (85.7%) had one or more predisposing risk factors for gastrointestinal bezoars. The most common predisposing risk factor was a history of previous gastric surgery which was identified in 18 patients (42.8%). Twenty three patients (54.8%) had multiple predisposing risk factors. Phytobezoars were identified in all patients except one who had a trichobezoar in the stomach. Non-operative endoscopic fragmentation was performed either initially or after unsuccessful medical treatment in 14 patients with gastric bezoars and was completely successful in 10 patients (71.5%). Surgery was the most frequent treatment method in our study, which was required in 28 patients (66.7%). Intestinal obstruction secondary to bezoars was the most common complication (n = 18, 42.8%) in our study.
CONCLUSION: The presence of multiple predisposing factors may create a synergistic effect in the development of bezoars.
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Serrano KD, Tupesis JP. Small bowel obstruction from potato and broccoli phytobezoar mimicking mesenteric ischemia. J Emerg Med 2011; 44:79-81. [PMID: 22051841 DOI: 10.1016/j.jemermed.2011.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/24/2011] [Accepted: 06/02/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bezoars are concretions of undigested foreign material that form in the gastrointestinal tract. Rare in humans, they are nonetheless a well-documented cause of intraluminal bowel obstruction. OBJECTIVES The objectives of this case report include describing an unusual presentation of small bowel obstruction due to phytobezoar, which mimicked mesenteric ischemia, and highlighting the risk factors, presentation, and management of bezoars, in addition to covering historical beliefs regarding bezoars. CASE REPORT Here we report a 64-year-old man who presented to the Emergency Department with chest pain, vomiting, and hypotension. Initial work-up was directed at ruling out cardiac causes and aortic catastrophe such as aortic dissection or ruptured abdominal aortic aneurysm. Computed tomography angiography of the chest and abdomen showed findings suggestive of mesenteric ischemia and small bowel obstruction. However, exploratory laparotomy revealed intraluminal small bowel obstruction from a phytobezoar consisting of undigested chunks of potato, brussels sprouts, and broccoli. CONCLUSIONS Although rare in humans, bezoars are a documented cause of small bowel obstruction, and should be considered when intraluminal bowel obstruction occurs. Bezoars causing small bowel obstruction require surgical treatment.
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Affiliation(s)
- Karen D Serrano
- Division of Emergency Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin 53792, USA
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Yoon SS, Kim MS, Kang DY, Yun TS, Jeon JH, Lee YK, Choi SW, Kim CH. A case of successful colonoscopic treatment of colonic obstruction caused by phytobezoar. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:211-4. [PMID: 21980592 PMCID: PMC3180602 DOI: 10.3393/jksc.2011.27.4.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 06/30/2011] [Indexed: 10/28/2022]
Abstract
A phytobezoar is the most common type of bezoar, which is a gastrointestinal mass composed of vegetable. A persimmon is a common cause of a phytobezoar. The majority of bezoars are found in the stomach, with the small intestine being the next most commonly involved site. The colon is a rare site for a bezoar. Recently, we experienced a colonic bezoar that caused colonic obstruction in a 66-year-old female patient who took persimmons regularly. The patient came to the hospital because of abdominal pain and distension. To differentiate a tumor or other problems that can cause intestinal obstruction, we performed an abdominal computed tomography scan and found an ovoid intraluminal mass with a mottled gas pattern in the distal descending colon. A large impacted bezoar was seen in the sigmoid colon, which was completely obstructed, and it was successfully removed by using colonoscopy.
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Affiliation(s)
- Sang Seok Yoon
- Department of Internal Medicine, Good Gang-An Hospital, Busan, Korea
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Sarhan M, Shyamali B, Fakulujo A, Ahmed L. Jejunal Bezoar causing obstruction after laparoscopic Roux-en-Y gastric bypass. JSLS 2011; 14:592-5. [PMID: 21605530 PMCID: PMC3083057 DOI: 10.4293/108680810x12924466008682] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The authors report on 2 patients who had small bowel obstruction secondary to phytobezoars following Roux-en-Y gastric bypass. Bowel obstruction is a known complication of Roux-en-Y gastric bypass. It can be caused by adhesions, internal hernia, incarcerated ventral hernia, or intussusception. Sometimes the underlying cause may be unusual. These 2 case reports describe patients who underwent laparoscopic Roux-en-Y gastric bypass and whose postoperative courses were complicated by small-bowel obstruction due to phytobezoars in the ileum, distal to the jejunojejunal anastomosis. We reviewed the literature by using PubMed and Medline for causes, pathogenesis, classifications, diagnosis, and management.
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Slesak G, Mounlaphome K, Inthalad S, Phoutsavath O, Mayxay M, Newton PN. Bowel obstruction from wild bananas: a neglected health problem in Laos. Trop Doct 2011; 41:85-90. [PMID: 21421885 PMCID: PMC3125700 DOI: 10.1258/td.2011.100293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We investigated the significance and risk factors of bowel obstruction caused by the consumption of wild bananas (BOWB) in Laos. Of six patients with BOWB in Luang Namtha, North Laos, five required enterotomy for phytobezoars. All had eaten wild banana (WB) seeds. Of 227 other patients/relatives: 91.2% had eaten WB; 46.3% had also eaten the seeds and 45.4% knew of complications resulting from eating WB; 42.3% were aware of the complications of ingesting the seeds (constipation [37.9%], appendicitis/abdominal pain/vomiting [2.6% each] and bloated stomach/death [1.3% each]). Middle/highland Lao ethnicity was associated with WB and seed consumption (odds ratio [OR] 9.91 and 2.33), male sex with WB consumption and unawareness (OR 4.31 and 1.78). At all surgically-equipped hospitals in Laos, 33/44 doctors knew of BOWB, describing patients as young adults (16/30), male (24/30) and from middleland Lao (18/30). Countrywide, 46/48 patients with BOWB required laparotomy in 2009 (incidence 0.8/100,000). All consumed WB seeds. BOWB is widespread in Laos, especially among young middleland Lao men consuming WB seeds on an empty stomach.
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