Bezoar-induced Small Bowel Obstruction

Abstract

PurposeThe 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.MethodsWe retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010.ResultsThirteen 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).ConclusionA 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.

Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

“…Previous studies have described the CT imaging characteristics of phytobezoars and the small-bowel faeces sign individually [6,7,10,12,13]. Ho et al [14] and Oh et al [15] further proposed the mechanisms of the two disease entities. A phytobezoar is the end product of food debris, which causes SBO in an active manner and is always at the transition point [16].…”

Small bowel obstruction due to dried fruit and vegetable bezoars in paediatric patients of northern India.

“…The sensitivity and specificity of CT scan in diagnosing the bezoars has been reported to be 90% and 57%, respectively (16,17). In one study CT scan correctly diagnosed obstruction due to phytobezoars in 50% of the patients while rest were diagnosed on water soluble contrast study and laparotomy (18). It was also noted that CT scan correctly identified the site of obstruction in the 4 patients with bezoars which was ileal in 3 and jejunal in 1 patient.…”

Two cases of small bowel obstruction secondary to a swallowed potato

“…Oh et al 4 reported 20 cases of bezoar-induced small bowel obstruction (BI-SBO). They concluded 4% of all small bowel obstructions to be caused by bezoar.…”

“…They concluded 4% of all small bowel obstructions to be caused by bezoar. It is more prevalent in people with delayed gastric emptying (eg, after gastrectomy or vagotomy), or in those with hypothyroidism or autonomic neuropathy (eg, diabetic) 4. The series identified that the commonest location of bezoar causing small bowel obstruction was 50–70 cm proximal to the ileocaecal valve.…”

“…Oh et al 4 concluded that diagnosis of a bezoar as the cause of small bowel obstruction on a CT scan was important for early treatment. Of their 20 patients, 9 (45%) were diagnosed with bezoar on initial investigation, 7 with CT scan and 2 using small bowel series.…”