Phytobezoar: A Rare Cause of Small Bowel Obstruction

Authors

DOI:

https://doi.org/10.22502/jlmc.v8i2.364

Keywords:

Phytobezoar, Small Bowel Obstruction, Sepsis

Abstract

Introduction: Small bowel obstruction is a common condition encountered in surgical practice. However, obstruction due to phytobezoars is a rarity. Until recently, phytobezoars were incidental findings during surgery however advances in imaging have eased the diagnosis by precisely identifying and locating the etiology. Case: An 86-year-old lady presented to the emergency room with abdominal pain, distension, and inability to pass stool and flatus. Workup showed she had features of small bowel obstruction with features of sepsis with worsening of preexisting respiratory co-morbidity. Exploration showed a phytobezoar causing the bowel obstruction. Conclusion: Phytobezoar though uncommon should always be thought of while treating a case of intestinal obstruction in the elderly age group. Surgery is the mainstay of treatment. However preexisting co-morbid condition plays a vital role in the outcome.

Downloads

Download data is not yet available.

Author Biographies

  • Rajiv Nakarmi, Manmohan Memorial Medical College and Teaching Hospital

    Junior Consultant,

    Department of General and Laparoscopic Surgery.

  • Muza Shrestha, Manmohan Memorial Medical College and Teaching Hospital

    Senior Consultant,

    Department of General and Laparoscopic Surgery.

  • Sunder Maharjan, Manmohan Memorial Medical College and Teaching Hospital

    Registrar,

    Department of General and Laparoscopic Surgery.

References

Teng H, Nawawi O, Ng K, Yik Y. Phytobezoar: an unusual cause of intestinal obstruction. Biomed Imaging Interv J. 2005 Jul;1(1):e4. doi:10.2349/biij.1.1.e4. Epub 2005 Jul 1. PMID: 21625276; PMCID: PMC3097591.

Senol M, Ozdemir ZÜ, Sahiner IT, Ozdemir H. Intestinal Obstruction due to Colonic Lithobezoar: A Case Report and a Review of the Literature. Case Rep Pediatr. 2013; 2013:854975. doi: 10.1155/2013/854975. PMID: 23424701; PMCID: PMC3562610.

Williams RS. The fascinating history of bezoars. Med J Aust. 1986 Dec 1-15;145(11-12):613-4. PMID: 3540541.

Andrus CH, Ponsky JL. Bezoars: classification, pathophysiology, and treatment. The American Journal of Gastroenterology. 1988 May;83(5):476-478.

Chintamani, Durkhure R, Singh JP, Singhal V. Cotton Bezoar--a rare cause of intestinal obstruction: case report. BMC Surg. 2003 Sep 4;3:5. doi: 10.1186/1471-2482-3-5. PMID: 12956890; PMCID: PMC194753.

Altintoprak F. Gastric outlet syndrome associated with a recurrent trichobezoar: report of a case. Turk J Gastroenterol. 2010 Dec;21(4):471-2. doi: 10.4318/tjg.2010.0143. PMID: 21332010.

Ashfaq A, Madura JA 2nd, Chapital AB. An unusual case of biliary bezoar causing small bowel obstruction in a patient with ampullary diverticulum and stapled gastroplasty. BMJ Case Rep. 2014 Dec 9; 2014:bcr2014207455. doi: 10.1136/bcr-2014-207455. PMID: 25498113; PMCID: PMC4265041.

Macari M, Megibow A. Imaging of suspected acute small bowel obstruction. Semin Roentgenol. 2001 Apr;36(2):108-17. doi: 10.1053/sroe.2001.22827. PMID: 11329653.

Kement M, Ozlem N, Colak E, Kesmer S, Gezen C, Vural S. Synergistic effect of multiple predisposing risk factors on the development of bezoars. World J Gastroenterol. 2012 Mar 7;18(9):960-4. doi: 10.3748/wjg.v18.i9.960. PMID: 22408356; PMCID: PMC3297056.

Krausz MM, Moriel EZ, Ayalon A, Pode D, Durst AL. Surgical aspects of gastrointestinal persimmon phytobezoar treatment. Am J Surg. 1986 Nov; 152(5):526-30. doi: 10.1016/0002-9610(86)90221-7. PMID: 3777332.

Bowden TA Jr, Hooks VH 3rd, Mansberger AR Jr. The stomach after surgery. An endoscopic perspective. Ann Surg. 1983 Jun; 197(6):637-44. doi: 10.1097/00000658-198306000-00001. PMID: 6859976; PMCID: PMC1352881.

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 Mar 28; 11(12):1813-7. doi: 10.3748/wjg.v11.i12.1813. PMID: 15793871; PMCID: PMC4305881.

Ezzat RF, Rashid SA, Rashid AT, Abdullah KM, Ahmed SM. Small intestinal obstruction due to phytobezoar: a case report. J Med Case Rep. 2009 Dec 2; 3:9312. doi: 10.1186/1752-1947-3-9312. PMID: 20062741; PMCID: PMC2803835.

Oh SH, Namgung H, Park MH, Park DG. Bezoar-induced Small Bowel Obstruction. J Korean Soc Coloproctol. 2012 Apr; 28(2):89-93. doi: 10.3393/jksc.2012.28.2.89. Epub 2012 Apr 30. PMID: 22606648; PMCID: PMC3349816.

Bedioui H, Daghfous A, Ayadi M, Noomen R, Chebbi F, Rebai W, et al. A report of 15 cases of small bowel obstruction secondary to phytobezoars: predisposing factors and diagnostic difficulties.Gastroenterol Clin Biol. 2008 June;32(6-7): 596-600.

Downloads

Published

2020-12-31

Issue

Vol. 8 No. 2 (2020): vol:8, No:2

Section

Case Report

License

  • The Journal of Lumbini Medical College (JLMC) publishes open access articles under the terms of the Creative Commons Attribution (CC BY) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
  • JLMC requires an exclusive licence to publish the article first in its journal in print and online.
  • The corresponding author should read and agree to the following statement before submission of the manuscript for publication,
    • License agreement
    • In submitting an article to Journal of Lumbini Medical College (JLMC) I certify that:
      1. I am authorized by my co-authors to enter into these arrangements.
      2. I warrant, on behalf of myself and my co-authors, that:
        1. the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights;
        2. I am/we are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to JLMC are not in breach of any other obligation;
        3. the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy;
        4. I/we have taken due care to ensure the integrity of the article. To my/our - and currently accepted scientific - knowledge all statements contained in it purporting to be facts are true and any formula or instruction contained in the article will not, if followed accurately, cause any injury, illness or damage to the user.
      3. I, and all co-authors, agree that the article, if editorially accepted for publication, shall be licensed under the Creative Commons Attribution License 4.0. If the law requires that the article be published in the public domain, I/we will notify JLMC at the time of submission, and in such cases the article shall be released under the Creative Commons 1.0 Public Domain Dedication waiver. For the avoidance of doubt it is stated that sections 1 and 2 of this license agreement shall apply and prevail regardless of whether the article is published under Creative Commons Attribution License 4.0 or the Creative Commons 1.0 Public Domain Dedication waiver.
      4. I, and all co-authors, agree that, if the article is editorially accepted for publication in JLMC, data included in the article shall be made available under the Creative Commons 1.0 Public Domain Dedication waiver, unless otherwise stated. For the avoidance of doubt it is stated that sections 1, 2, and 3 of this license agreement shall apply and prevail.

                            Please visit Creative Commons web page for details of the terms.

How to Cite

1.
Phytobezoar: A Rare Cause of Small Bowel Obstruction. J Lumbini Med Coll [Internet]. 2020 Dec. 31 [cited 2025 Oct. 7];8(2):284-7. Available from: https://jlmc.edu.np/index.php/JLMC/article/view/364