Search

To prove that ingestion of unpeeled persimmon is necessary for the development of a persimmon phytobezoar, we interviewed 15 patients, in most of whom this condition developed after peptic ulcer surgery. We compared the study group with a control group of 15 patients who had undergone peptic ulcer surgery but did not have a bezoar. In contrast with the control group, most patients with bezoars had ingested unpeeled fruits (p < 0.01). While ingestion of persimmon carried a 9.8-fold risk of bezoar development, ingestion of the unpeeled fruit increased the risk of this complication 56 times over that of age- and sex-matched controls. We recommend that patients who have undergone ulcer surgery be warned particularly against eating unpeeled persimmons.

Phytobezoars are frequently associated with partial gastrectomy and are generally considered benign. However, we report two patients who developed a gastric bezoar due to malignancy at the anastomotic site. Development of intragastric bezoar may be an indication of neoplastic growth sufficient to obstruct a small gastric outlet. Consequently, we conclude that endoscopic or surgical evaluation of the anastomotic site is necessary in patients who develop bezoars after gastric surgery.

Postoperative phytobezoars (duration from 2 months to 46 years) after surgery for duodenal ulcer disappeared in seven patients, by both x-ray and gastroscopy, on conservative approach aimed at the major role of delayed gastric emptying in phytobezoar formation. During a 3-day period, metoclopramide was given by drip infusion, 40 mg/24 hours, and the patient received only a copious clear diet, with no solid food. In one patient, two courses of treatment were necessary for complete elimination of the phytobezoar. None of the patients had any underlying disease. All but one had good dentition. "Disruption" of the bezoars allowed the discovery upon endoscopy of unusual etiological features such as carcinoma of the stoma and stomal polypoid hypertrophic gastritis (so-called gastritis cystica polyposa ) in one patient, and a retained suture narrowing the stoma in another.