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Intestinal obstruction due to bezoars: a retrospective clinical study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to compare the results of surgical procedures applied to rare intestinal obstruction cases due to bezoars and to identify effective factors for determining the type of surgical procedure to be applied.

Methods

The records of 62 patients who had received gastrointestinal surgical treatment due to bezoars were assessed retrospectively. The preoperative characteristics, perioperative findings and postoperative results of cases that had and had not undergone an enterotomy were compared

Results

The average patient age was 57.7 years (range, 26–84 years), and all patients had phytobezoars, except one. The most common location for bezoars was the jejunum (28 cases, 45.1 %). Sixteen cases (25.8 %) had multiple bezoars located in different parts of the gastrointestinal tract. While milking was applied to 26 cases (41.9 %) with small intestinal bezoars, an enterotomy was used to remove bezoars in 23 cases (37 %). More complications tended to be identified in patients who underwent an enterotomy; however, the difference was not significant (p = 0.553).

Conclusions

The frequency of previous abdominal surgery in patients suffering from an intestinal obstruction due to bezoars causes diagnostic conflict. The location of bezoars in the small intestine should also be considered when deciding the surgical procedure, as well as the physical properties of the bezoars. Our opinion is that conducting the milking procedure should not be insisted on, and that an enterotomy should be conducted when necessary.

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References

  1. Andrus CH, Ponsky JL. Bezoars: classification, pathophysiology, and treatment. Am J Gastroenterol. 1988;83(5):476–8.

    PubMed  CAS  Google Scholar 

  2. Kadian RS, Rose JF, Mann NS. Gastric bezoars—spontaneous resolution. Am J Gastroenterol. 1978;70(1):79–82.

    PubMed  CAS  Google Scholar 

  3. Erzurumlu K, Malazgirt Z, Bektas A, Dervisoglu A, Polat C, Senyurek G, Yetim I, Ozkan K. Gastrointestinal bezoars: a retrospective analysis of 34 cases. World J Gastroenterol. 2005;11(12):1813–7.

    PubMed  Google Scholar 

  4. Peck JJ, Milleson T, Phelan J. The role of computed tomography with contrast and small bowel follow-through in management of small bowel obstruction. Am J Surg. 1999;177(5):375–8.

    Article  PubMed  CAS  Google Scholar 

  5. Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S. Laparoscopic management of acute small bowel obstruction. Surg Endosc. 2005;19(4):464–7.

    Article  PubMed  CAS  Google Scholar 

  6. Gayà J, Barranco L, Llompart A, Reyes J, Obrador A. Persimmon bezoars: a successful combined therapy. Gastrointest Endosc. 2002;55(4):581–3.

    Article  PubMed  Google Scholar 

  7. Escamilla C, Robles-Campos R, Parrilla-Paricio P, Lujan-Mompean J, Liron-Ruiz R, Torralba-Martinez JA. Intestinal obstruction and bezoars. J Am Coll Surg. 1994;179(3):285–8.

    PubMed  CAS  Google Scholar 

  8. Rubin M, Shimonov M, Grief F, Rotestein Z, Lelcuk S. Phytobezoar: a rare cause of intestinal obstruction. Dig Surg. 1998;15(1):52–4.

    Article  PubMed  CAS  Google Scholar 

  9. Chisholm EM, Leong HT, Chung SC, Li AK. Phytobezoar: an uncommon cause of small bowel obstruction. Ann R Coll Surg Engl. 1992;74(5):342–4.

    PubMed  CAS  Google Scholar 

  10. Dirican A, Unal B, Tatli F, Sofotli I, Ozgor D, Piskin T, Kayaalp C, Kirimlioglu V. Surgical treatment of phytobezoars causes acute small intestinal obstruction. Bratisl Lek Listy. 2009;110(3):158–61.

    PubMed  CAS  Google Scholar 

  11. Swift RI, Wood CB, Hershman MJ. Small bowel obstruction due to phytobezoars in the intact gastrointestinal tract. J R Coll Surg Edinb. 1989;34(5):267–9.

    PubMed  CAS  Google Scholar 

  12. Kim JH, Ha HK, Sohn MJ, Kim AY, Kim TK, Kim PN, Lee MG, Myung SJ, Yang SK, Jung HY, Kim JH. CT findings of phytobezoar associated with small bowel obstruction. Eur Radiol. 2003;13(2):299–304.

    Article  PubMed  Google Scholar 

  13. Taourel PG, Fabre JM, Pradel JA, Seneterre EJ, Megibow AJ, Bruel JM. Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction. Am J Roentgenol. 1995;165(5):187–92.

    Google Scholar 

  14. Bedioui H, Daghfous A, Ayadi M, Noomen R, Chebbi F, Rebai W, Makni A, Fteriche F, Ksantini R, Ammous A, Jouini M, Kacem M, Bensafta Z. A report of 15 cases of small-bowel obstruction secondary to phytobezoars: predisposing factors and diagnostic difficulties. Gastroenterol Clin Biol. 2008;32(6–7):596–600.

    Article  PubMed  CAS  Google Scholar 

  15. Quiroga S, Alvarez-Castells A, Sebastià MC, Pallisa E, Barluenga E. Small bowel obstruction secondary to bezoar: CT diagnosis. Abdom Imaging. 1997;22(3):315–7.

    Article  PubMed  CAS  Google Scholar 

  16. Hoover K, Piotrowski J, St Pierre K, Katz A, Goldstein AM. Simultaneous gastric and small intestinal trichobezoars—a hairy problem. J Pediatr Surg. 2006;41(8):1495–7.

    Article  PubMed  Google Scholar 

  17. Wang YG, Seitz U, Li ZL, Soehendra N, Qiao XA. Endoscopic management of huge bezoars. Endoscopy. 1998;30(4):371–4.

    Article  PubMed  CAS  Google Scholar 

  18. Lin CS, Tung CF, Peng YC, Chow WK, Chang CS, Hu WH. Successful treatment with a combination of endoscopic injection and irrigation with coca cola for gastric bezoar-induced gastric outlet obstruction. J Chin Med Assoc. 2008;71(1):49–52.

    Article  PubMed  Google Scholar 

  19. Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc. 2007;21(11):1945–9.

    Article  PubMed  Google Scholar 

  20. Sosa J, Gardner B. Management of patients diagnosed as acute intestinal obstruction secondary to adhesions. Am Surg. 1993;59(2):125–8.

    PubMed  CAS  Google Scholar 

  21. Seror D, Feigin E, Szold A, Allweis TM, Carmon M, Nissan S, Freund HR. How conservatively can postoperative small bowel obstruction be treated? Am J Surg. 1993;165(1):121–6.

    Article  PubMed  CAS  Google Scholar 

  22. Assalia A. Small-bowel obstruction secondary to bezoar impaction: a diagnostic dilemma (invited commentary). World J Surg. 2007;31:1079–80.

    Google Scholar 

  23. Ho TW, Koh DC. Small-bowel obstruction secondary to bezoar impaction: a diagnostic dilemma. World J Surg. 2007;31(5):1072–8.

    Article  PubMed  Google Scholar 

  24. Nobili P, Dassi FL, Annolfi B, Ronchi O. Intestinal obstruction due to phytobezoars. G Chir. 1993;14(1):41–4.

    PubMed  CAS  Google Scholar 

  25. Lo CY, Lau PW. Small bowel phytobezoars: an uncommon cause of small bowel obstruction. Aust N Z J Surg. 1994;64(3):187–9.

    Article  PubMed  CAS  Google Scholar 

  26. Aysan E, Demir M, Kinaci E, Basak F. Complications of intestinal milking: experimental model. ANZ J Surg. 2005;75(5):322–5.

    Article  PubMed  Google Scholar 

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Correspondence to F. Altintoprak.

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Altintoprak, F., Dikicier, E., Deveci, U. et al. Intestinal obstruction due to bezoars: a retrospective clinical study. Eur J Trauma Emerg Surg 38, 569–575 (2012). https://doi.org/10.1007/s00068-012-0203-0

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  • DOI: https://doi.org/10.1007/s00068-012-0203-0

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