Bezoars: A comprehensive review of the literature with analysis of 30 collected cases

Aim: The aim of the present study was to discuss the operated cases for bezoar and the treatment results in comparison to the literature.Material and Methods: We retrospectively reviewed 30 cases operated due to bezoar in our hospital from 2008 to 2017. Demographic characteristics, comorbidities, obstruction locations, dietary habits, clinical findings, diagnostic and therapeutic methods, and the outcomes of the patients were recorded from the patient files.Results: Thirty cases of bezoar were found. One patient was treated two times due to recurrence. The distribution of cases according to the monthly prevalence was observed as 4 patients in November, 10 patients in January, 9 patients in December, 3 patients in February (86.6% in autumn and winter). Twenty-one patients (70 %) had a history of abdominal surgery. Eighteen (% 60) patients also had gastric surgery. Surgery revealed 18 (%60) bezoar cases in the jejunum and ileum. Five (%16.6) patients had bezoars found concurrently in the stomach and ileum and in 7 patients (%23.3) had bezoars in the stomach. Fragmentation and milking were done to three patients, resection-anastomosis was performed to one patient, enterotomy was performed to 16 patients, gastroenterostomy was performed to 3 patients, enterotomy and gastrotomy were performed to 2 patients, gastrectomy was performed to one patient and gastrotomy was performed to 4 patients. The average days of patients stayed at the hospital were 12.83 ± 14.2 (6-84) days.Conclusion: IBO caused by bezoar is still a rare diagnosis. This case must be considered for intestinal bowel obstruction encountered in patients with previously undergone gastric surgery and fibrous food consumption, especially in autumn and winter months.

PDF

___

1. Yasar M, Aslaner A, Turgut T, et al. Diospyrobezoar in jejunum causing ıntestinal obstruction: a rare case report. Düzce Tıp Fakültesi Dergisi 2005;2:29-32.
2. Ertugrul G, Coskun M, Sevinc M, et al. A rare cause of gastrointestinal phytobezoars: diospyros lotus. World J Emerg Surg 2012;7:19.
3. Liu C, Deng H, Zhang Z, et al. Small bowel obstruction secondary to a mushroom bezoar: Case Report. Int J Geron 2012;6:295-7.
4. Fallon SC, Slater BJ, Larimer EL, et al. The surgical management of rapunzel syndrome: a case series and literature review. J Pediatr Surg 2013;48:830-4.
5. Saeed ZA, Rabassa AA, Anand BS. An endoscopic method for removal of duodenal phytobezoars. Gastrointest Endosc 1995;41:74-6
6. Norberg PB. Intestinal obstruction due to food. Surgery GynecObstet 1961;113:149-52.
7. Krausz MM, Moriel EZ, Ayalon A, et al. Surgical aspects of gastrointestinal persimmon phytobezoar treatment. Am J Surg 1986;152:526-30.
8. Oh SH, Namgung H, Park MH, et al. Bezoar-induced Small Bowel Obstruction. J Korean Soc Coloproctol 2012;28:89-93.
9. Ho TW, koh DC. small-bowel obstruction Secondary to Bezoar Impaction: A Diagnostic Dilemma. World J Surg 2007;31:1072-8.
10. Kim JH, Ha HK, Sohn MJ, et al. CT findings of phytobezoar associated with small bowel obstruction. Eur Radiol 2003;13:299-304.
11. Lorimer JW, Allen MW, Toa H, et al. Small-bowel carcinoid presenting in association with a phytobezoar. Can J Surg 1991;34:331-3.
12. Ko YT, Lim JH, Lee DH, et al. Small intestinal phytobezoar Sonographic detection. Abdom Imaging 1993;18:271-3.
13. Frager D, Medwid SW, Baer JW, et al. CT of small-bowel obstruction: Value in establishing the diagnosis and determining the degree and cause. Am J Roentgenol 1994;162:37-41.
14. Naveau S, Poynard T, Zourabichvili O, et al. Gastric phytobezoar destruction by Nd: YAG laser therapy (letter). Gastrointest Endosc 1986;32:430-1.
15. Guner A, Kahraman I, Aktaş A, et al. Gastric outlet obstruction due to duodenal bezoar: A casereport. Int J Surg Case Rep 2012;3:523-5
16. Hayashi K, Ohara H, Naitoh I, et al. Persimmon bezoar successfully treated by oral intake of coca-cola: a case report. Cases J 2008;1:385.
17. Nelson RS. Nonoperative management of persimmon bezoar. a successful modification of traditional papain therapy. Am J Gastroenterol 1980;74:264-6.
18. Gáyá J, Barranco L, Llompart A, et al. Persimmon bezoars: a successful combined therapy. Gastrointest Endosc 2002;55:581-3.
19. Fukuya T, Hawes DR, Lu CC, et al. CT diagnosis of small-bowel obstruction: Efficacy in 60 patients. Am J Roentgenol 1992;158:765-9.
20. Lo CY, Lau PW. Small bowel phytobezoars: an uncommon cause of small bowel obstruction. Aust N Z J Surg 1994;64:187-9.
21. De Bakey M, Oschner A. Bezoars and concretions: comprehensive review of literature, with analysis of 303 collected cases and presentation of 8 additional cases. Surgery 1938;4:934-63.