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Riaz M, Akbar I, Hassan RE, Ahmad W, Khan H, Khan AU, Khan MH, Shah SS, Tahir A, Tanveer S. Effect of Coca-Cola on the Dissolution of Persimmon-Related Phytobezoar in a Tertiary Care Hospital. Cureus 2024; 16:e54420. [PMID: 38510864 PMCID: PMC10951130 DOI: 10.7759/cureus.54420] [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: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Bezoars, masses of indigestible foreign bodies formed in the gastrointestinal tract, pose challenges in their management. Phytobezoars are particularly problematic due to their difficult diagnosis and resilience towards treatment. Recently, Coca-Cola has emerged as a potential solution due to its acidic composition and mucolytic properties. However, existing evidence is limited, highlighting the need for comprehensive studies. This research explores the efficacy of Coca-Cola in dissolving persimmon-related phytobezoars, aiming to contribute valuable insights to non-invasive treatment options. Material and methods Conducted as a descriptive case series, this study employed gastric cola lavage using non-probability purposive sampling. Patients aged 18-70 with persimmon-related phytobezoars were included. Two nasogastric tubes were inserted for cola lavage over 12 hours, utilizing three liters of cola until the disappearance of symptoms. When the bezoar disappeared, it was considered as complete success to the treatment. Results Out of 31 patients, 45.2% were male and 54.8% were female, with a mean age of 56.77 ± 9.01 years. Efficacy was noted in 54.8% of cases. Age less than 50 and no history of diabetes mellitus were associated with higher chances of treatment success (p-value ≤0.05). Conclusion Ingestion of Coca-Cola was highly effective, safe, and reliable for the dissolution of persimmon-related phytobezoars, as the frequency of efficacy was high in our study. Coca-Cola ingestion is a non-invasive and cost-effective mode of phytobezoar dissolution that should be taken as a first-line initial treatment option to attain desired outcomes.
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Affiliation(s)
- Maryam Riaz
- Surgery, Ayub Teaching Hospital, Abbottabad, PAK
| | - Ismail Akbar
- Surgery, Ayub Teaching Hospital, Abbottabad, PAK
| | - Rao E Hassan
- Orthopedics and Trauma, Khyber Teaching Hospital-Medical Training Institute (MTI), Peshawar, PAK
| | - Waheed Ahmad
- General Surgery, Hayatabad Medical Complex-Medical Training Institute (MTI), Peshawar, PAK
| | - Hassamullah Khan
- General Surgery, Hayatabad Medical Complex-Medical Training Institute (MTI), Peshawar, PAK
| | | | | | - Syeda Sunaina Shah
- General Surgery, Hayatabad Medical Complex-Medical Training Institute (MTI), Peshawar, PAK
| | - Asna Tahir
- Ophthalmology, Khyber Teaching Hospital-Medical Training Institute (MTI), Peshawar, PAK
| | - Safina Tanveer
- Surgery, Khyber Teaching Hospital-Medical Training Institute (MTI), Peshawar, PAK
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2
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Miyagishima D, Inoue M, Kinjo K, Fujimoto K, Suzuki H, Sugimura K, Kubota M, Nakagawa A, Kikuchi Y, Shinozaki M, Fujimoto H. Bowel Obstruction due to Shiitake Mushrooms: Diagnostic Features on Computed Tomography. Intern Med 2022; 61:3349-3354. [PMID: 35466167 PMCID: PMC9751717 DOI: 10.2169/internalmedicine.9181-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Shiitake mushrooms are edible mushrooms popular in East Asian cuisine. We herein report a 69-year-old man with abdominal distension and vomiting after ingesting several pieces of sautéed Shiitake mushrooms. Abdominal computed tomography (CT) revealed ring-shaped and crescent-shaped low-density objects (-100 to -300 Hounsfield units) in the ileum. Based on the specific shapes and CT numbers of the foreign bodies, he was diagnosed with small bowel obstruction due to Shiitake mushrooms. After conservative treatment, he passed four pieces of Shiitake mushrooms. Despite the rarity, the condition can be diagnosed before exploratory surgery by careful and detailed interpretation of CT findings.
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Affiliation(s)
- Daisuke Miyagishima
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Masanori Inoue
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Kaori Kinjo
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Kentaro Fujimoto
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Hiromasa Suzuki
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Kaoru Sugimura
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Michio Kubota
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Akihiko Nakagawa
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Yasuharu Kikuchi
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Masami Shinozaki
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Hajime Fujimoto
- Comprehensive Radiology Center, Chiba University Hospital, Japan
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3
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Taha Y, Salman K, Alrayyes F, Alrayyes S. An unusual case of phytobezoar-induced small bowel obstruction. J Surg Case Rep 2019; 2019:rjz296. [PMID: 31723401 PMCID: PMC6831952 DOI: 10.1093/jscr/rjz296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/06/2019] [Indexed: 12/31/2022] Open
Abstract
Bezoars, and to lesser extent phytobezoars, are among the rare causes of small bowel obstruction. A bezoar generally describes retained concretions of indigestible foreign material that accumulate and conglomerate in the gastrointestinal tract, most commonly in the stomach. We present an unusual case of phytobezoar-induced sub-acute small bowel obstruction originating from unfamiliar plant material in a 74-year-old woman. The past history was insignificant regarding comorbidities other than depression. Presenting complaints were history of abdominal pain and vomiting. Imaging studies and physical examination suggested small bowel obstruction. The patient underwent exploratory laparotomy after 1 day of conservative treatment. We found a 4.5 cm obstructing phytobezoar intraoperatively. The undigested plant material caused the obstruction. Postoperatively, the plant was identified as Scorzonera papposa. The patient was discharged uneventfully. The elderly patients should avoid semi-cooked vegetables, plants of unknown origin and high-fibre diet.
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Affiliation(s)
- Yasser Taha
- Department of General Surgery, Prince Mutaib bin Abdulaziz, Sakaka, Saudi Arabia
| | - Khaled Salman
- Department of General Surgery, Prince Mutaib bin Abdulaziz, Sakaka, Saudi Arabia
| | - Fahad Alrayyes
- Department of General Surgery, Prince Mutaib bin Abdulaziz, Sakaka, Saudi Arabia
| | - Saad Alrayyes
- College of Medicine, Jouf University, Sakaka, Saudi Arabia
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4
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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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5
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Chestnut-phytobezoar causing small bowel obstruction in a child with Dravet syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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6
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Yamamoto M, Yamamoto K, Bian X, Guo Q, Sasaki T, Yamamoto F, Yamamoto H. Small Bowel Obstruction Caused by Dried Persimmon. Case Rep Gastroenterol 2018; 12:147-152. [PMID: 29805358 PMCID: PMC5968236 DOI: 10.1159/000488527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/14/2018] [Indexed: 12/24/2022] Open
Abstract
Dried persimmon is a well-known dried fruit in Asian countries such as Japan, Korea, and China. Small bowel obstruction caused by phytobezoar is a rare but interesting pathogenesis that accounts for 2–4% of all small bowel obstructions. We present the case of an 87-year-old female who suffered from small bowel obstruction caused by ingestion of a huge, dried astringent persimmon. She was initially treated conservatively, but removal by enterotomy was performed after relief failed to be achieved with conservative therapy.
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Affiliation(s)
- Mami Yamamoto
- Department of Surgery, Yamamoto Memorial Hospital, Imari, Japan
| | | | - Xueyi Bian
- Department of Surgery, Yamamoto Memorial Hospital, Imari, Japan
| | - Qiang Guo
- Department of Surgery, Yamamoto Memorial Hospital, Imari, Japan
| | | | - Fumio Yamamoto
- Department of Surgery, Yamamoto Memorial Hospital, Imari, Japan
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7
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Lu L, Zhang XF. Gastric Outlet Obstruction--An Unexpected Complication during Coca-Cola Therapy for a Gastric Bezoar: A Case Report and Literature Review. Intern Med 2016; 55:1085-9. [PMID: 27150859 DOI: 10.2169/internalmedicine.55.5567] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Gastric bezoars are concretions of undigested material, and Coca-Cola therapy is an easy, efficacious and safe approach for bezoar treatment. Gastric outlet obstruction due to a migratory gastric bezoar during Coca-Cola therapy is an uncommon presentation and, to the best of our knowledge, no cases have been previously reported. We herein describe one such case with no known predisposing factors that recovered via the endoscopic technique. A thorough literature search was performed, which yielded eight relevant patients from seven publications, all of who developed gastrointestinal obstruction during dissolution treatment and recovered uneventfully after surgical intervention. In conclusion, this potential complication should be kept in mind in the event that alternative treatment is necessary.
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Affiliation(s)
- Lei Lu
- Hangzhou First People's Hospital, Nanjing Medical University, China
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8
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Satake R, Chinda D, Shimoyama T, Satake M, Oota R, Sato S, Yamai K, Hachimori H, Okamoto Y, Yamada K, Matsuura O, Hashizume T, Soma Y, Fukuda S. Repeated Small Bowel Obstruction Caused by Chestnut Ingestion without the Formation of Phytobezoars. Intern Med 2016; 55:1565-8. [PMID: 27301506 DOI: 10.2169/internalmedicine.55.6811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A small number of cases of small bowel obstruction caused by foods without the formation of phytobezoars have been reported. Repeated small bowel obstruction due to the ingestion of the same food is extremely rare. We present the case of 63-year-old woman who developed small bowel obstruction twice due to the ingestion of chestnuts without the formation of phytobezoars. This is the first reported case of repeated small bowel obstruction caused by chestnut ingestion. Careful interviews are necessary to determine the meal history of elderly patients and psychiatric patients.
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Affiliation(s)
- Ryu Satake
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Japan
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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: 56] [Impact Index Per Article: 5.6] [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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10
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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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11
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Bae JM, Lee YK. Extremely rare case of extrahepatic duct phytobezoar treated with intraoperative transenteral endoscopy. Ann Surg Treat Res 2014; 87:100-103. [PMID: 25114890 PMCID: PMC4127900 DOI: 10.4174/astr.2014.87.2.100] [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: 11/11/2013] [Revised: 01/08/2014] [Accepted: 01/14/2014] [Indexed: 11/30/2022] Open
Abstract
Phytobezoar is a rare cause of gastro-intestinal tract obstruction. Common sites of phytobezoar are the stomach and small bowel. Naturally, extrahepatic duct phytobezoar is near impossible due to anatomical structure and location such as ampulla of vater, common bile duct and bifurcation of bile duct. Here, we present an extremely rare case of extrahepatic duct phytobezoar that resulted in abdominal pain. We successfully treated the case with extraoperative transenteral endoscopic removal of phytobezoar. For its great rarity and particular treatment approach, we report this case with review of literature.
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Affiliation(s)
- Jung Min Bae
- Department of Surgery,Yeungnam University College of Medicine, Daegu, Korea
| | - Yong Kook Lee
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
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12
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Işik A, Deniz Firat Y, Peker K, Sayar İ, İdiz O, Soyturk M, Demiryilmaz I, Yilmaz I. How could such a wide piece of tree root pass through the narrow pyloric orifice? An extremely rare case. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:284-287. [PMID: 25009689 PMCID: PMC4089776 DOI: 10.12659/ajcr.890713] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/20/2014] [Indexed: 12/12/2022]
Abstract
PATIENT Female, 30 FINAL DIAGNOSIS: Phytobezoar Symptoms: Nausea • vomiting MEDICATION - Clinical Procedure: - Specialty: - OBJECTIVE Rare disease. BACKGROUND Phytobezoars are a common type of bezoar known to accumulate in the gastrointestinal system. CASE REPORT A 30-year-old mentally retarded woman was operated on due to small bowel obstruction. A piece of tree root was extracted from the ileum. The patient was discharged from the hospital on postoperative day 7. CONCLUSIONS Due to difficulties in determining the nature of the bezoar preoperatively, small bowel obstruction due to a phytobezoar is not a common diagnosis. For bezoars, prevention is considered preferable to treatment.
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Affiliation(s)
- Arda Işik
- Department of General Surgery, Erzincan University, Erzincan, Turkey
| | - Y. Deniz Firat
- Department of General Surgery, Erzincan University, Erzincan, Turkey
| | - Kemal Peker
- Department of General Surgery, Erzincan University, Erzincan, Turkey
| | - İlyas Sayar
- Department of Pathology, Erzincan University, Erzincan, Turkey
| | - Oguz İdiz
- Department of General Surgery, Yunak State Hospital, Konya, Turkey
| | - Mehmet Soyturk
- Department of Radiology, Erzincan University, Erzincan, Turkey
| | | | - Ismayil Yilmaz
- Department of General Surgery, Erzincan University, Erzincan, Turkey
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Tiwari A, Gupta V, Hazrah P, Chaudhary AK, Lal R. Fitobezoar: rara causa de obstrução aguda do intestino delgado em abdome inocente. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 26:342-3. [DOI: 10.1590/s0102-67202013000400020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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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: 0.8] [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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15
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Kim Y, Park BJ, Kim MJ, Sung DJ, Kim DS, Yu YD, Lee JH. Biliary phytobezoar resulting in intestinal obstruction. World J Gastroenterol 2013; 19:133-136. [PMID: 23326176 PMCID: PMC3542761 DOI: 10.3748/wjg.v19.i1.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 09/16/2012] [Accepted: 09/28/2012] [Indexed: 02/06/2023] Open
Abstract
Phytobezoar is the most common type of bezoar. It is composed of indigestible vegetable matter and is usually found in the stomach. Biliary phytobezoar is extremely rare and difficult to diagnose preoperatively. The pathogenesis is not clear, and there have been only a few reports of biliary bezoars associated with sphincteric impairmentat the ampulla of Vater. Here, we present a report of biliary bezoar that resulted in jejunal obstruction. We were unable to identifythe bezoar in the extrahepatic bile duct until it obstructed the small bowel lumen. To our knowledge, this is the first report of small bowel obstruction resulting frommigration of a biliary bezoar.
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16
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de Toledo AP, Rodrigues FH, Rodrigues MR, Sato DT, Nonose R, Nascimento EF, Martinez CAR. Diospyrobezoar as a cause of small bowel obstruction. Case Rep Gastroenterol 2012; 6:596-603. [PMID: 23271989 PMCID: PMC3529578 DOI: 10.1159/000343161] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.
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