A case of small bowel obstruction due to phytobezoars

Abstract

Approximately 2–4 per cent of small bowel obstructions (SBO) are caused by bezoars. In addition, presentation with features of acute surgical abdomen is extremely rare, accounting for only 1% of the patients. A bezoar is a concretion of indigestible material found in the gastrointestinal tract, which usually forms in the stomach and passes into the small bowel, where it can cause SBO. We present the case of a 63-year-old male who presented with SBO following ingestion of boiled olive leaves as herbal treatment for diabetes mellitus.

Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings

“…Typical phytobezoars appear as a well-defined, ovoid, or round intraluminal mottled-appearing mass containing air bubbles in the interstices [ 2 – 5 , 16 , 21 ]. A few phytobezoars also appear as a soft tissue mass without air, making diagnosis difficult, as it can resemble an intraluminal tumor [ 15 ].…”

“…The location of the bezoars was categorized as proximal (duodenum to proximal jejunum), middle (mid-jejunum to mid-ileum), distal (distal ileum), or multisegmental (involving more than one segment) according to modified Cole's method [ 19 ]. The node or mass was classified as phytobezoar appearance: a round, ovoid, or tubular, well-defined, heterogeneous, intraluminal mass with a mottled air pattern [ 2 – 5 , 16 , 21 ]; calcareous bezoar appearance: a well-defined, round or ovoid, intraluminal hyper dense nodule [ 20 ]; and trichobezoar appearance: a large, well-circumscribed, nonhomogeneous lesion in the lumen of the stomach with a tail extending up to the jejunum or beyond, which was composed of concentric whorls of different densities comprising pockets of air enmeshed within it [ 21 , 22 ]. Maximum length and width of the bezoar were measured on the transverse images and maximum craniocaudal depth was measured on the coronal images.…”

Intussusception caused by dried apricot: A case report

“…Several case reports exist about small bowel obstructions caused by phytobezoars. 1–7 A great variety of foods have been described to cause a bowel obstruction secondary to phytobezoars, including grapefruit, mango, green figs, pickled fruits and vegetables, brussels sprouts, broccoli, peppers, and dried fruits such as apricots, figs, peaches, and prunes. Phytobezoars are high cellulose containing foods are resistant to enzymatic break down in the human gastrointestinal chain, thus further contributing to intestinal obstruction.…”

Treatment of phytobezoars: Tailoring management to diverse presentation

“…Phytobezoars are accumulations of indigestible fibers and seeds of fruits and vegetables; trichobezoars comprise hair, bristles, and feathers; lactobezoars are formed of milk and milk products; and pharmacobezoars are the result of copious intake of medication. Phytobezoars are the most common form of bezoar and are usually detected in the stomach (1). The presentation of bezoars may vary from subtle, dyspepsia-like symptoms to more pronounced findings, such as ileus.…”