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The word ‘bezoar’ comes from either the Persian word ‘padzahr’ or the Arabic word ‘badzehr’ both of which denote ‘antidote.’ This word meant a hard stone found in the stomach of the Syrian goat and believed to prevent poisoning1.

Background Although adhesions account for more than 70% of small bowel obstruction (SBO), they are thought to be less likely aetiologies in patients without previous abdominal surgery. Expedient surgery has historically been advocated as prudent management in these patients. Emerging evidence appears to challenge such a dogmatic approach. Methods A retrospective analysis was performed in all SBO patients with a virgin abdomen admitted between January 2012 and August 2014. Patients with obstruction secondary to abdominal wall hernias were excluded. Patient demographics, clinical presentation, management strategy and pathology involved were reviewed. Results A total of 72 patients were included in the study. The majority of patients were males (66.7%), with a median age of 58 years (range: 23-101). Abdominal pain (97%) and vomiting (86%) were the most common presentations while abdominal distention (60%) and constipation (25%) were reported less frequently. Adhesions accounted for the underlying cause in 44 (62%) patients. Other aetiologies included gallstone ileus (n = 5), phytobezoar (n = 5), intussusception (n = 4), internal herniation (n = 4), newly diagnosed small bowel tumour (n = 3), mesenteric volvulus (n = 3), stricture (n = 3) and Meckel's diverticulum (n = 1). Twenty-nine (40%) patients were successfully managed conservatively while the remaining 43 (60%) underwent surgery. The intraoperative findings were in concordance with the preoperative computed tomography scan in 76% of cases. Conclusion Adhesions remain prevalent despite the absence of previous abdominal surgery. Non-operative management is feasible for SBO in a virgin abdomen. Computed tomography scan can be a useful adjunct in discerning patients who may be treated non-operatively by elucidating the underlying cause of obstruction.

Bezoars are concretions of undigested or partially digested foreign material in the gastrointestinal or genitourinary tract of humans or animals. Originally described from Persia, they have been known to mankind for centuries. Bezoars are an uncommon cause of benign mechanical gastric outlet obstruction. A variety of materials have been found to form bezoars, such as hair, undigested food, persimmons, milk products, medicines, etc. Development of bezoars is usually associated with predisposing risk factors. We describe a very unusual case of duodenal date seed bezoar causing partial gastric outlet obstruction in a person with no known risk factors. To the best of our knowledge, duodenal bezoars formed by date seeds have not been reported previously in the English literature.

A 47‐year‐old male patient was admitted to the department of abdominal surgery with 6‐month history of epigastric pain and weight loss up to 15 kg. EGD revealed a giant gastric phytobezoar. Eating habits of the patient, coming from the south of Russia, included raw stinging nettle. Nonsurgical treatment including attempts of endoscopic mechanical fragmentation and diet coke ingestion appeared to be unsuccessful. The patient underwent laparotomy and gastrotomy with phytobezoar extraction as shown in Video S1. Postoperatively the patient recovered uneventfully.

Phytobezoars associated with diabetic gastroparesis are often sources of diminished quality of life for patients. Poor blood sugar control has been associated with increasing gastroparesis. For recipients of pancreas transplants to correct diabetes, phytobezoar treatment post-transplant can typically be limited to invasive procedures and prokinetic agents. We present the case of an alternative treatment to phytobezoar, cola libation, i.e., "cola-lysis."

Obturation of the small bowel is an uncommon but important cause of small bowel obstruction. There are a great number of substances that may impact at the narrow portions of the small bowel. More than one object may be present in the alimentary tract and should be actively sought. Certain groups of patients are more likely to suffer from the condition. We present two cases of small bowel obstruction due to obturation and review the relevant literature.