Diospyrobezoar: an uncommon cause of obstructive ileus
A bezoar is an accumulation of ingested foreign material. Three major categories exist, depending on their composition: trichobezoar, formed by ingested hair, pharmacobezoar, formed by indigestible medication contents, and phytobezoar formed by indigestible food fibres, most commonly the diospyrobezoar, which consists of persimmon fruit, which was eaten by our patient in large quantities [1, 2]. The indigestible food fibres form a mass and finally an obstructive ileus. Diagnosis is usually made by CT scan or ultrasound. Conservative treatment modalities described are endoscopic removal, pulverizing the bezoar with YAG laser therapy or extra-corporal shock wave lithotripsy, or chemical dissolution of the bezoar with for instance cellulase or Coca-Cola [2, 3]. Our patient was advised to drink 3 l of Coca-Cola every 24 h to dissolve the cellulose in the diospyrobezoar. At follow-up, his complaints and the duodenal bezoar had disappeared, while the bezoar in the stomach was still present.