Mechanical intestinal obstruction due to phytobezoar: Retrospective cohort study

INTRODUCTION: In this study, we aimed to look through our patients with intestinal obstruction (IO) due to phytobezoars.
METHODS: Patients with intestinal obstruction due to phytobezoar between April 2013 and January 2017 were evaluated in this study.
RESULTS: There were 13 patients. Seven patients were female; six patients were male, and the mean age was 54.6. Six of the patients had a history of gastric re–section, two patients had severe tooth disturbances, and two patients had diabetes. In four patients, there was a story of eating persimmon (diospyrobezoar). Three of the patients were diagnosed with computerized tomography (CT) and nine of the patients with the laparotomy. Two patients had bezoars in the endoscopy. Two patients were treated nonoperatively. Intravenous (IV) fluid, nasogastric decompression, oral cola beverage and IV metoclopramide were administered. The patients requiring surgery were operated within 72 hours. In the laparotomy, bezoars were found in the ileum and four also in the stomach. In three of the patients, bezoars were crushed manually and then transferred to ileum; in eight of the patients, bezoars were extracted with enterotomy. Two of the patients who had enterotomy, underwent re–laparotomy due to a leak, and these two patients were lost. Superficial wound infection developed in four patients. Specimens were reported as a phytobezoar in pathology reports.
DISCUSSION AND CONCLUSION: Phytobezoars should be kept in mind in differential diagnosis in ileus patients with a gastric operation history and dental problems. Patients’ detailed anamnesis and eating habits should be questioned. CT and endoscopy may help. Patients with partial obstruction may benefit from conservative treatment.