An unusual case of gastric outlet obstruction caused by multiple giant persimmon phytobezoars

Tan, Fengbo; Mo, Hongbin; He, Xiao Shun; Pei, Haiping

doi:10.1093/gastro/gow042

Cited by 10 publications

(22 citation statements)

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“…Phytobezoars are the most common type of bezoars, and the most common risk factors for phytobezoar formation are previous gastric surgery, poor mastication, overindulgence of food with high fiber content, diabetes mellitus complicated by gastroparesis and coexisting diseases with delayed gastric emptying such as mixed connective tissue diseases, and hypothyroidism 7 . Impaired gastric peristalsis, low gastric acidity, and loss of normal pyloric function can all contribute to phytobezoar formation 1 . Patients with phytobezoars may experience epigastric pain or discomfort, nausea, vomiting, early satiety, weight loss, diarrhea, dysphagia, or upper gastrointestinal ulcerations and hemorrhage 1,7 …”

Section: Discussionmentioning

confidence: 99%

“…3,5,8 Prior to the 1960s, phytobezoars were often treated with surgery; however, presently most treatment is conservative. 1,5 A wide variety of therapeutic options have since been reported, including medical treatment with cellulase, papain, metoclopramide, or N-acetylcysteine. 1 Chemical dissolution is another treatment option using either Coca-Cola lavages or hydrolytic solutions.…”

Section: F I G U R Ementioning

confidence: 99%

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Case report—An unusual diagnosis of a gastric phytobezoar in a middle‐aged woman

Chineka

Mukosera

Dzvanga

et al. 2021

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 99%

Case report—An unusual diagnosis of a gastric phytobezoar in a middle‐aged woman

Chineka

Mukosera

Dzvanga

et al. 2021

Clinical Case Reports

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“…Bezoar is the accumulation of indigestible or poorly digestible substances in the gastrointestinal tract [ 1 ]. There are four types of bezoars: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars.…”

Section: Introductionmentioning

confidence: 99%

“…Phytobezoars account for less than 4% of small bowel obstructions [ 3 ] and double localization accounts for only 10,75 % of total cases of phytobezoars [ 4 ]. Rarely, they can form and stop in the stomach due to flexible gastric volume [ 1 ]. Being bifocal is even rarer.…”

Section: Introductionmentioning

confidence: 99%

Phytobezoar: A train can hide another

Mejri

Trigui

2021

International Journal of Surgery Case Reports

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Highlights A very rare cause of acute intestinal obstruction without diagnostic peculiarities. The patient's particular profile and his past medical history should mainly guide the diagnosis. The abdominal CT scan can improve the diagnosis, but it should not delay management. Exploring the entire digestive tract intraoperatively is an imperative procedure that can be life-saving.

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550

L e t t e r t o t h e E d i t o rDear Sir, Persimmons contain large amounts of soluble tannin, which may interact with gastric acid to form a conglomerate that is harder than other phytobezoars. (1) The presence of ingestible fruit tannins, cellulose, hemicellulose and lignins in persimmons make such a phytobezoar more difficult to dissolve or segment into smaller divisions due to its hard consistency. (2) This makes persimmon phytobezoars particularly difficult to manage.

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mentioning

confidence: 99%

Persimmon fruit causing simultaneous small bowel and stomach obstruction

Teng¹,

Tan²,

Shelat³

2019

smedj

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550 L e t t e r t o t h e E d i t o rDear Sir, Persimmons contain large amounts of soluble tannin, which may interact with gastric acid to form a conglomerate that is harder than other phytobezoars. (1) The presence of ingestible fruit tannins, cellulose, hemicellulose and lignins in persimmons make such a phytobezoar more difficult to dissolve or segment into smaller divisions due to its hard consistency. (2) This makes persimmon phytobezoars particularly difficult to manage. We report a case of multiple persimmon phytobezoars causing simultaneous small bowel and gastric outlet obstruction.A 39-year-old woman was admitted to our hospital with symptoms of nausea, vomiting and epigastric pain. She had no past medical illness. On examination, she had a distended abdomen without scars and no external hernias. Blood investigations and imaging established a diagnosis of intestinal obstruction. Computed tomography established a diagnosis of small bowel intestinal obstruction with grossly distended stomach. There was no reporting of 'bezoar' by the on-duty radiologist. However, the surgical team adjudged the possibility of an intraluminal mass in the distal bowel and retrospectively asked the patient about her dietary history. She confirmed that she had eaten four persimmons from her own farm ten days ago. A clinical diagnosis of small bowel obstruction secondary to persimmon phytobezoar was established.A 5-cm phytobezoar obstruction in the distal small bowel was retrieved through an enterotomy with primary repair. Another 15 cm × 6 cm sausage-shaped phytobezoar was retrieved from the stomach through a gastrotomy and primary repair (Fig. 1). We postulated that the small bowel phytobezoar in our patient represented the 'daughter' phytobezoar from the 'parent' giant gastric phytobezoar. Her postoperative recovery was uncomplicated, and the patient remained well at the sixmonth follow-up.Old age, poor dentition, previous gastrectomy, diabetes mellitus and hypothyroidism can increase the risk of bezoar formation due to problems with digestion or gut motility. The clinical manifestation of the bezoar is dependent on the location of the obstruction. Small bowel obstruction is the most common manifestation. The majority of phytobezoars pass spontaneously (80%-90%); some can be retrieved through an endoscopy (10%-20%) and surgery is rarely needed (< 1%). (3,4) Recently, the use of effervescent aerated drinks such as Coca-Cola has been reported in the management of phytobezoars. (5) This is an attractive management option, as it avoids surgical intervention and its resultant morbidity. However, there is an increased risk of the occurrence of secondary 'daughter' phytobezoars.In our patient, endoscopy and Coca-Cola were not advocated due to her small bowel obstruction. In patients with multiple bezoars causing intestinal obstruction, laparotomy is considered more effective to concurrently remove all the bezoars. One should also check for the possibility of more bezoars to avoid early recurrent obstruction from the 'missed' bezoar...

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An unusual case of gastric outlet obstruction caused by multiple giant persimmon phytobezoars

Cited by 10 publications

References 10 publications

Case report—An unusual diagnosis of a gastric phytobezoar in a middle‐aged woman

Case report—An unusual diagnosis of a gastric phytobezoar in a middle‐aged woman

Phytobezoar: A train can hide another

Persimmon fruit causing simultaneous small bowel and stomach obstruction

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