Phytobezoar: A Brief Report with Surgical and Radiological Correlation

Abstract

Gastrointestinal bezoars, collections of incompletely digested material within the alimentary tract, can present as a diagnostic challenge and should be considered in the differential diagnosis and management of small bowel obstruction, ischemic bowel, or bowel perforation. We present a case of a 37-year-old man with a distant history of laparotomy for superior mesenteric artery thrombosis requiring partial small bowel resection of the jejunum who presented with worsening abdominal pain, nausea, vomiting, and hematemesis. An abdominal computed tomography revealed dilated loops of small bowel with a transition point at the ileum, distal to his prior bowel anastomosis. He was managed initially nonoperatively, but persistent vomiting and worsening distention necessitated urgent exploratory laparotomy. During the procedure, a 4 cm by 3 cm phytobezoar was discovered at the midjejunum. The patient had an unremarkable postoperative course with no further symptoms at 1-year follow-up. Timely diagnosis and treatment of bezoar is essential to minimize patient complications.

Phytobezoar-Induced Mechanical Ileus and Incipient Intussusception: A Case Report

“…Trichobezoars comprise hair, and their discovery usually discloses an underlying psychiatric disorder, such as trichotillomania and trichophagia [ 2 ]. Pharmacobezoars occur as a result of indigested medications; this is commonly seen in laxatives, slow-released tablets, as well as in medications that have an enteric barrier coating [ 1 , 2 , 5 , 6 ]. Phytobezoars constitute the most common type of bezoars; their main compounds are cellulose, hemicellulose, lignin, tannins, and pectins [ 1 , 7 ].…”

“…Bezoars in the small intestine are either primarily formed there or have migrated from the stomach through the pyloric valve [ 1 ]. They are usually located in the ileum, owing to the anatomical and physiological features of the region [ 6 ]. Colonic, esophageal, rectal, and biliary bezoars are more infrequent [ 9 , 10 , 11 , 12 ].…”

“…Hypothyroidism, diabetes mellitus, inflammatory bowel diseases (IBD), malignancies of the GI tract, and neurologic conditions, namely scleroderma and myotonic dystrophy, can also be the instigators of the aforementioned physiological dysfunctions. Moreover, medications such as cholestyramine, anti-acids, anticholinergics, and tricyclic antidepressants can cause gastroparesis [ 2 , 6 , 15 ]. A distinct subcategory of phytobezoars, seed bezoars, tends to affect people without any predisposing factors; they manifest with different prevailing symptoms and require other forms of treatment, as they are usually located in the rectum [ 16 ].…”

“…If the patient’s clinical status and the phytobezoar’s location do not dictate immediate surgical intervention, conservative methods can primarily be attempted. Gastric phytobezoars are more accessible; metoclopramide can facilitate gastric emptying [ 4 , 6 ]. Dissolution or fragmentation of these conglomerates can be achieved by administering proteolytic enzymes such as papain and cellulase.…”

Obstrução Intestinal Por Tricobezoar Em Cão – Relato De Caso

“…Thrall et al (2015) relatam dentre as causas de hipoalbuminemia em cães, a deficiência alimentar de fontes proteicas e o catabolismo aumentado da albumina, como consequência de deficiência energética; estes fatores poderiam justificar tal alteração na paciente deste relato, haja vista a hiporexia significativa apresentada pelo animal. Em humanos com tricobezoares gastrointestinais, a anemia já foi relatada por Lopez et al (2014) Bezoares gastrintestinais podem levar a complicações graves, incluindo obstrução do intestino delgado, isquemia intestinal ou perfuração (HIRJI et al, 2018). O animal relatado foi submetido à enterectomia, para resolução da obstrução intestinal e retirada do segmento do íleo que alojava o tricobezoar, já que apresentavam áreas de isquemia e necrose.…”