Intestinal Obstruction Caused by Persimmon Bezoar: A Case Report

Small Bowel Obstruction Caused by an Aggressive Weight Loss Diet in a Patient With No Predisposing Factors

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.

Phytobezoar: An Unusual Condition Leading to Small Bowel Obstruction

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.

Molecular basis of the formation and removal of fruit astringency

Astringency is a dry puckering mouthfeel mainly generated by the binding of tannins with proteins in the mouth. Tannins confer benefits such as resistance to biotic stresses and have antioxidant activity, and moderate concentrations of tannins can improve the flavor of fruits or their products. However, fruits with high contents of tannins have excessive astringency, which is undesirable. Thus, the balance of astringency formation and removal is extremely important for human consumption of fruit and fruit-based products. In recent years, the understanding of fruit astringency has moved beyond the biochemical aspects to focus on the genetic characterization of key structural genes and their transcriptional regulators that cause astringency. This article provides an overview of astringency formation and evaluation. We summarize the methods of astringency regulation and strategies and mechanisms for astringency removal, and discuss perspectives for future exploration and modulation of astringency for fruit quality improvement.

Reconstructed gastric conduit obstruction caused by a bezoar after esophagectomy: a case report

BACKGROUND

Bezoars are rare but may cause gastrointestinal obstruction and ulcers. To the best of our knowledge, only two cases of bezoars in the reconstructed gastric conduit have been reported, but there has been no report on reconstructed gastric conduit obstruction due to bezoars.

CASE PRESENTATION

A 60-year-old man presented to our clinic with abdominal pain and vomiting that occurred suddenly after dinner. Three years before presentation, he had undergone radical thoracoscopic esophagectomy followed by reconstruction of the gastric conduit through the posterior sternum, for esophageal cancer. Enhanced computed tomography scans showed distension of only the gastric conduit without ischemia and distension of the small intestine. According to our findings, we initially diagnosed the patient with postoperative intestinal obstruction caused by adhesions. After conservative treatment failed, the patient underwent an endoscopic study that showed a bezoar at the pylorus ring. We initially failed to remove the bezoar endoscopically because of its large size; hence, we attempted enzymatic dissolution. Three days after the first endoscopic study, the bezoar was disintegrated using a snare and extracted during a second endoscopy. The patient recovered uneventfully and presented with no complications during the 1-year follow-up interval.

CONCLUSION

In cases wherein the discharge of materials in the reconstructed gastric conduit is delayed, bezoars should be considered in the differential diagnosis, and an endoscopic study should be performed to verify the cause of obstruction.

Obstructive Bezoars of the Small Bowel Treated with Coca-Cola Zero through a Long Intestinal Tube and Endoscopic Manipulation

An 82-year-old Japanese man visited our hospital with abdominal fullness accompanied by lower abdominal pain. He presented with small bowel obstruction due to multiple diospyrobezoars. The bezoars were successfully removed without any surgical intervention by the administration of Coca-Cola Zero through a long intestinal tube and subsequent endoscopic manipulation. Such a combination may be the treatment of choice for small bowel obstruction due to bezoars.