Phytobezoar: An Unusual Condition Leading to Small Bowel Obstruction

Abstract

Bezoar is described as a swallowed, extraneous, and indigestible mass located in the gastrointestinal system; it accounts for 0.4-4.0% of all cases of mechanical intestinal obstruction. Intestinal obstruction is the most frequent complication of bezoar formation. Apart from intestinal obstructions, bezoars may also exhibit clinical symptoms such as abdominal pain, nausea, vomiting, weight loss, upper gastrointestinal bleeding, and gastric perforation. However, a considerable number of cases tend to be asymptomatic. Of note, its clinical symptoms cannot be differentiated easily from intestinal obstructions caused by other factors. As such, preoperative CT examination can provide invaluable information about the level of obstruction, etiology, and the existence of additional pathology and thereby help plan the type of surgical procedure required. If prompt diagnosis and timely treatment are not carried out, the condition may lead to significant morbidity and mortality.

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

“…Wang et al have also suggested that an increased CT value could prognosticate the need for surgical intervention [ 22 ]. However, in our patient’s case, there was an absence of the aforementioned pathognomonic finding, which has also been reported in the literature; this predicament can hinder setting a definitive preoperative diagnosis [ 20 ]. It is useful to consider the additional benefits of a magnetic resonance imaging (MRI) scan in case of an inconclusive CT scan.…”

“…Imaging tests are essential for diagnosing and differentiating cases of intestinal obstruction. CT appears to be the most advantageous test, especially in setting an early diagnosis of a phytobezoar, with the characteristic “mottled gas pattern” of an intraluminal mass [ 1 , 20 , 21 ]. Wang et al have also suggested that an increased CT value could prognosticate the need for surgical intervention [ 22 ].…”

Unveiling a Silent Obstructor: Phytobezoar in the Third Duodenal Segment

“…Phytobezoar refers to the formation of a mass in the gastrointestinal tract due to the consumption of non-digestible substances such as fiber (Aydin et al, 2022). Foods with high cellulose, lignin, and tannin content, when exposed to the acidic stomach environment, polymerize and clump together, promoting the formation of a sticky substance to which other materials adhere, gradually hindering its transport through the digestive system.…”

“…Small bowel obstruction is a common condition, primarily attributed to intestinal adhesions and hernias; etiology secondary to bezoars is unusual, accounting for only 2-4% of reported cases (Aydin et al, 2022). Bezoars act as foreign bodies in the gastrointestinal tract, arising after the ingestion of undigested organic material, leading to intraluminal mechanical intestinal obstruction.…”

“Bezoar Egg”—A Rare Cause of Small Bowel Obstruction

“…It is difficult to distinguish the clinical symptoms of bezoar-induced small bowel obstruction (BI-SBO) from those caused by other factors leading to intestinal obstruction [5,6]. The most common manifestations are complete mechanical intestinal obstruction, leading to symptoms such as abdominal pain, bloating, nausea, and vomiting [2,6].…”