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Objectives Although phytobezoars are the most common type of gastric bezoar, a standardized treatment method has not been adopted. Methods In this study, we evaluated patient clinical features and treatment outcomes following the use of different treatment methods, with a focus on the efficacy of carbonated beverage consumption. A review of medical charts and endoscopic reports revealed 15 cases of gastric phytobezoars from September 2008 to May 2016. Patient medical records were retrospectively reviewed to assess patient clinical characteristics and treatment results. Results The mean patient age was 71.3±11.1 years. The most common symptoms were epigastric pain (46.7%) and bloating (40.0%). A history of intra-abdominal surgery was found in 26.7% of the patients. The mean bezoar size was 47.3±14.5 mm. The final successful treatment methods were consumption of a carbonated beverage alone (n=7, 46.7%), endoscopic removal (n=5, 33.3%), and surgery (n=3, 20.0%). During the treatment course, few patients (3/15, 20.0%) experienced small bowel obstructions after the consumption of the carbonated beverage and endoscopic fragmentation; these obstructions required surgical interventions. There was no significant difference in the baseline characteristics between patients successfully or unsuccessfully treated with the carbonated beverage. Conclusions Most patients presenting with gastric phytobezoars can be successfully treated by consuming carbonated beverages in conjunction with endoscopic therapy. However, small bowel obstructions may occur due to the migration of a fragmented bezoar, necessitating surgical intervention.

Phytobezoar causing acute intestinal obstruction is a rare event. A case of accidental ingestion of mango seed causing intestinal obstruction is being reported requiring surgical intervention to extract the mango seed from the ileum. This condition must be kept in mind during the mango season while dealing with a case of intestinal obstruction in an emergency.

Bezoars are indigestible masses of material forming within the gastrointestinal system. Phytobezoars are the most common subtype consisting of plant matter such as fibre, skins, and seeds. Rarely they present causing small bowel obstruction (SBO) and may be difficult to distinguish from faecalization on imaging. Here we present the case of a man in his 70s who rapidly consumed an expiring bag of peanuts and subsequently developed a SBO due to formation of a peanut phytobezoar. After failing conservative management, he required emergency surgery with intentional enterotomy to milk out the bezoar. This case highlights the importance of maintaining a broad differential and thorough history taking in patients presenting with SBO. [ABSTRACT FROM AUTHOR]

The trichobezoar is the most frequent etiology of bezoar, however, the importance of fitobezoar (seeds) in a tropical climate like Tabasco stands out. A study of ten cases that underwent surgery in the last 5 years at the “Dr. Rodolfo Nieto Padrón” Children’s Hospital is presented. The clinical and radiological characteristics and surgical findings are described. The female sex predominates in 70% and the school age. 70% were secondary to trichobezoar and 30% to fitobezoar. Found as a cause of papaya, cocoa and nance seeds. The rest predominated Tricobezoar. All underwent exploratory laparotomy and enterotomy or gastrostomy and psychological support was provided to, there were no recurrences. A comparison of the reports in the literature is made and the importance of the presence of fitobezoar as findings in a tropical area such as the geographical area of Tabasco is highlighted. Diagnosis is essential, so it should be suspected in pediatric patients who present data of gastric occlusion. The importance of thinking about the suspicion of ingestion of fruit seeds as a cause of bezoar in children is described. There are no preventive measures because they are fruits of habitual consumption in rural areas. [ABSTRACT FROM AUTHOR]

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Phytobezoars constitute conglomerates of indigested plant fibers and are a rare cause of acute mechanical ileus. They exhibit an increased prevalence in the elderly population and people with specific predisposing conditions. Radiological imaging can often set a definitive diagnosis and dictate the optimal therapeutic approach, combined with the patient's clinical status. An 81-year-old male presented with deteriorating clinical symptoms of intestinal obstruction, and an exploratory laparotomy was performed following inconclusive radiological findings; multiple phytobezoars and incipient intussusception were revealed intraoperatively. A patient's medical history can often raise clinical suspicion of phytobezoars. However, a careful etiological investigation is imperative in all cases of mechanical ileus in advanced ages; early detection and dissolution of phytobezoars, when applicable, can reduce the need for surgical interventions. [ABSTRACT FROM AUTHOR]

Nerium oleander is a plant containing cardiac glycosides, and intoxication with its leaves is a medical emergency. We report the case of a 73-year-old man who took a decoction of oleander leaves for a reckless purpose. Upon arrival in the emergency room, he presented an altered state of consciousness, drooling and vomiting. He was bradycardic with intermittent third- degree atrioventricular block and typical downsloping ST-segment depression related to glycosides toxicity. Despite initial treatment with atropine, isoprenaline and repeated bolus of digoxin-specific antibody (Fab) fragments, symptoms were persistent 12 hours after admission. Suspecting that the patient not only drank the decoction but also ingested the leaves and had slow gastric emptying, we performed gastric lavage without benefit. We subsequently performed a gastroscopy that showed an oleander phytobezoar, and its removal permitted a rapid clinical improvement. Treatment with digoxin-specific antibodies for intoxication is well described and dosage should be adapted to the plasmatic level. Such an examination is useless in oleander intoxication because it does not represent the real quantity of toxin. The dosage of antibodies is empiric and should be guided by the clinical severity. In such intoxication, the presence of a phytobezoar from oleander leaves cannot be excluded so we believe that a gastroscopy for its mechanical removal should always be considered to avoid persistent release of toxin.

Duodenal diverticula perforation due to an impacted bezoar is a rare disease. Surgical treatment is associated with high rates of complications and mortality; therefore, treatment strategies must be carefully decided. Endoscopic treatment offers significant benefits to patients over surgery. Duodenal diverticula perforation due to an impacted bezoar was performed endoscopic treatment. Endoscopic treatment offers significant benefits to patients over surgery. [ABSTRACT FROM AUTHOR]

Abstract Duodenal diverticula perforation due to an impacted bezoar is a rare disease. Surgical treatment is associated with high rates of complications and mortality; therefore, treatment strategies must be carefully decided. Endoscopic treatment offers significant benefits to patients over surgery.

Seed bezoars are a subcategory of phytobezoars caused by undigested vegetable seeds or fruit pits. We report the case of a 48-year-old woman who was admitted due to severe constipation and rectal pain. Rectal examination was notable for numerous sunflower seeds at the anal verge. Initial CT imaging revealed fecal impaction with a rectal bezoar which was managed with manual evacuation. Repeat CT imaging was notable for a gastric bezoar which was successfully managed by dissolution therapy with Coca-Cola. Most seed bezoars can be managed conservatively and life-threatening complications are rare., Competing Interests: Conflicts of interest: None to report., (© 2024 Greater Baltimore Medical Center.)

Phytobezoars are solid masses of indigestible plant material and are a common type of gastrointestinal bezoar, with varying incidences globally. These bezoars typically form from the ingestion of high-fiber fruits and vegetables and are associated with factors such as decreased gastric acid production and delayed gastric emptying. We present a case of a 35-year-old healthy man with recurrent upper abdominal pain, nausea, a rolling ball sensation in the abdominal region, and a history of consuming unripe persimmons. Imaging revealed the presence of phytobezoars in the stomach, leading to unsuccessful endoscopic attempts at removal. Laparoscopic extraction was eventually performed successfully after failed conservative management. The case highlights the rarity of diospyrobezoars, a subtype of phytobezoars formed from persimmon ingestion, and the challenges in their management. Surgical intervention, particularly laparoscopic extraction, can be effective but carries risks such as surgical site infections. Comprehensive care involving diagnostic imaging, non-surgical interventions, and surgical techniques is crucial for the successful management of phytobezoars. Phytobezoars, though relatively common, present unique diagnostic and management challenges, especially when formed from specific dietary factors such as persimmons. Understanding their epidemiology, clinical manifestations, and treatment options, including the role of laparoscopic surgery, is essential for optimizing patient outcomes and minimizing complications such as surgical site infections., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Odeh et al.)

Phytobezoars constitute conglomerates of indigested plant fibers and are a rare cause of acute mechanical ileus. They exhibit an increased prevalence in the elderly population and people with specific predisposing conditions. Radiological imaging can often set a definitive diagnosis and dictate the optimal therapeutic approach, combined with the patient’s clinical status. An 81-year-old male presented with deteriorating clinical symptoms of intestinal obstruction, and an exploratory laparotomy was performed following inconclusive radiological findings; multiple phytobezoars and incipient intussusception were revealed intraoperatively. A patient’s medical history can often raise clinical suspicion of phytobezoars. However, a careful etiological investigation is imperative in all cases of mechanical ileus in advanced ages; early detection and dissolution of phytobezoars, when applicable, can reduce the need for surgical interventions.

IntroductionSmall bowel obstruction is a common surgical emergency abdominal condition in clinical practice. Fecalith is one of the rare causative factors, especially phytobezoars.Case ReportWe report the case of a 66-year-old man admitted with “abdominal pain with vomiting for 1 day.” Enhanced CT of the abdomen suggested incomplete small bowel obstruction. The symptomatic treatment with fasting, fluid replacement, gastrointestinal decompression, and antibiotics was conducted after the patient was admitted to the hospital. After 2 days of treatment, the patient's abdominal pain was not significantly relieved, so a decision was made to perform laparoscopic examination surgery. During surgery, a columnar foreign body was found embedded in the lumen of the small intestine about 10 cm away from the ileocecal region. Combined with the patient's preoperative history of consuming a large number of persimmons, the primary diagnosis of small intestinal fecalith obstruction was considered. We performed an enterotomy to remove the foreign body, and the procedure was uneventful. On postoperative day 7, the patient was successfully discharged.ConclusionWhen we encounter a patient with intestinal obstruction without a history of surgery in our clinical work, we should take a careful history, especially about the consumption of foods that can cause phytoliths. When a patient has consumed a large amount of food that can cause phytobezoars before the abdominal pain, we should diagnostically consider it as phytobezoars intestinal obstruction, which helps to reduce the incidence of misdiagnosis and allows the patient to receive treatment timely and effectively.

ABSTRACT: Digestive disorders in cattle are associated with the breeding system and feed provided to the animals. Abomasal compaction is primarily related to the ingestion of forage with elevated levels of lignin, low quality, and difficult digestibility. In addition, the excess of fibrous food in the diet can lead to phytobezoars that may be responsible for intestinal obstruction disorders. This study aimed to describe pathological and clinical aspects of an outbreak of digestive disorders associated with the consumption of palm fiber (Elaeis guineensis). The outbreak struck a herd of 499 animals raised in a feedlot system after a change in diet that included an increase in the amount of palm fiber. Forty (8.01%) animals showed clinical signs such as fattening and regurgitation during rumination, and 21 (4.2%) animals died later. The cattle affected presented with apathy, emaciation, dehydration, distended abdomen, incomplete or absent ruminal movements, and congestive mucosa. Three animals were submitted to necropsy, and distended rumen and reticulum has a large amount of brownish liquid, long and tangled vegetable fibers with sand and stones. In two animals, the omasum had many rounded structures measuring approximately 5cm in diameter, made of vegetable fiber (phytobezoars). Abomasum of animals had similar material to the rumen, and one animal had compressed content. In two animals, dilatation was observed in the small intestine, and in the opening, the total obstruction of the lumen by phytobezoar was observed. During the follow-up of the slaughter of 76 cattle, 15 (19.7%) had phytobezoars of different sizes in the omasum and abomasum. The increased amount of oil palm fiber in animal feeding favored the occurrence of compression abomasum and intestinal obstruction phytobezoa, causing significant economic losses.

Early introduction of banana in newborn babies is still practiced by many mothers from different areas throughout the country and gastric perforation due to phytobezoars are sttll a problem tn the country. During the years 1984 through 1991 at the Children and Maternity Hospital Harapan Kita jakarta, fifteen neonates were treated for gastric perforation among which 6 were due to banana bezoar, 6 were due to deject of the gastric muscle, 2 were due to necrotizing enterocolitis (NEC) and 1 was due to iatrogenic duodenal obstruction. Pathogenesis of gastric perforation due to phytobezoar and the macroscopic and histopathological appearance of the perforation and its differences with perforations due to other causes were discussed.

Background: Phytobezoars are concretions of non-digestible vegetative matter in the gastroin­testinal tract and are a rare cause of intestinal obstruction in children. Case presentation: We report a case of intestinal obstruction in a 2-day-old neonate with no specific radiological features pointing to any common etiology. On exploratory laparotomy, a swollen raisin was found impacted in the ileum causing intestinal obstruction. The history taken in retrospect revealed that the elder sibling had witnessed her father perform a traditional ritual of putting a drop of honey into the mouth of the newborn and she imitated the same with a raisin, which led to the obstruction. Conclusion: A careful detailed history of local traditional rituals is at times, the most important pointer towards the etiology of a clinical condition. The basic clinical skill of history taking is still very important, despite the availability of advanced radiological investigations.

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.

Meckel's diverticulum is generally asymptomatic, but it may become symptomatic due to various reasons and maybe the etiology of the acute abdominal syndrome. Bezoars are formed by the combination of non-digestible substances in the gastrointestinal tract, and which are among the rare causes of intestinal obstruction. The formation of bezoars in Meckel's diverticulum and subsequent intestinal obstruction is a rare condition. In this article, two cases with intestinal obstruction due to bezoar in Meckel's diverticulum and their surgical treatment had presented. [ABSTRACT FROM AUTHOR]

Introduction Bezoars, masses of indigestible foreign bodies formed in the gastrointestinal tract, pose challenges in their management. Phytobezoars are particularly problematic due to their difficult diagnosis and resilience towards treatment. Recently, Coca-Cola has emerged as a potential solution due to its acidic composition and mucolytic properties. However, existing evidence is limited, highlighting the need for comprehensive studies. This research explores the efficacy of Coca-Cola in dissolving persimmon-related phytobezoars, aiming to contribute valuable insights to non-invasive treatment options. Material and methods Conducted as a descriptive case series, this study employed gastric cola lavage using non-probability purposive sampling. Patients aged 18-70 with persimmon-related phytobezoars were included. Two nasogastric tubes were inserted for cola lavage over 12 hours, utilizing three liters of cola until the disappearance of symptoms. When the bezoar disappeared, it was considered as complete success to the treatment. Results Out of 31 patients, 45.2% were male and 54.8% were female, with a mean age of 56.77 ± 9.01 years. Efficacy was noted in 54.8% of cases. Age less than 50 and no history of diabetes mellitus were associated with higher chances of treatment success (p-value ≤0.05). Conclusion Ingestion of Coca-Cola was highly effective, safe, and reliable for the dissolution of persimmon-related phytobezoars, as the frequency of efficacy was high in our study. Coca-Cola ingestion is a non-invasive and cost-effective mode of phytobezoar dissolution that should be taken as a first-line initial treatment option to attain desired outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Riaz et al.)

Introduction: Meckel’s Diverticulum (MD) affects approximately 2% of the population. Phytobezoar is defined as a vegetable and fiber-based ball in the gastrointestinal tract. We report a rare case of phytobezoar within MD presenting with partial intestinal obstruction. Case Reports: We hereby present a 20-year-old man who referred to the Emergency Department of a hospital with a two-day history of nausea, vomiting, abdominal pain, and constipation. He underwent a midline laparotomy with surgical exploration, which revealed an MD 60 cm proximal to ileocecal valve containing phytobezoar. Histopathology reported the extracted specimen as an MD without ectopic tissue. Conclusion: Meckel’s diverticulum can be affected by bezoars as well as other parts of the gastrointestinal tract. We recommend that phytobezoar within MD be considered among differential diagnosis of bowel obstruction.

Dried persimmon is a well-known dried fruit in Asian countries such as Japan, Korea, and China. Small bowel obstruction caused by phytobezoar is a rare but interesting pathogenesis that accounts for 2–4% of all small bowel obstructions. We present the case of an 87-year-old female who suffered from small bowel obstruction caused by ingestion of a huge, dried astringent persimmon. She was initially treated conservatively, but removal by enterotomy was performed after relief failed to be achieved with conservative therapy.

Phytobezoar is a rare cause of small bowel obstruction. This pathology represents 0.4%-4% of all mechanical bowel obstructions. Symptoms are similar to other small bowel obstructions. The most common localisation of the obstruction is represented by the terminal ileum. Phytobezoars are to be considered in patients who have had gastric surgery, a high fiber intake or psychiatric disorders. Also, multiple sclerosis has shown to affect bowel motility, which is important to our case. Surgery is always indicated. A low fiber diet and prokinetics are indicated for the prevention of this pathology. We present the case of a 43-year-old female who was admitted to the ICU following a car accident. The patient presented bowel obstruction symptoms (nausea and vomiting, bloating, not passing gas and severe abdominal pain) the 5th day after admission and was transferred to the operating room for exploratory laparotomy. Intraoperatively, we discovered a phytobezoar which was confirmed by the histopathological exam.

A 60-year-old man presented with abdominal pain. He was later diagnosed on imaging to have high-grade small bowel obstruction. The patient underwent surgery, and a hard, rounded bezoar resembling the endosperm of Nypa fruticans, colloquially known as attap chee, was found at the point of obstruction. Small bowel obstruction is a common acute surgical condition with multiple causes, including bezoars. We discuss the typical imaging features of bezoars causing small bowel obstruction as well as potential pitfalls that can mimic the appearance of a bezoar. [ABSTRACT FROM AUTHOR]

Bezoars are masses of partly or completely undigested materials created within the gastrointestinal tract (GI). Their incidence is low, less than 0.4% of all endoscopies of upper GI. According to the materials that compose them, bezoars are classified as phytobezoars, trichobezoars, pharmacobezoars, lactobezoars and various other types, such as paperbezoars, metalbezoars, parasitebezoars etc. Main predisposing factors are a previous gastric surgical intervention, poor mastication, high consumption of raw fruits and vegetables, as well as various chronic diseases. Bezoars may cause symptoms that range from mild abdominal pain, anorexia, dysphagia to symptoms of GI hemorrhage including hematemesis, hematochesia, melena and symptoms of intestinal obstruction or perforation including abdominal contraction, hypotension and shock. The diagnosis of bezoars has evolved along with the technological progress of computerized tomography (CT) and endoscopy. The former through helical multi-sliced CT and the use of contrast substances constitutes the imaging technique of choice, while the latter through high definition cameras and monitors may contribute crucially, either to diagnosis or treatment via chemical bezoar disintegration or mechanical fragmentation. In case these masses are located in the lower GI, cause serious complications or conservative methods are unsuccessful, then surgery is the only choice. Open surgery with enterotomy as the main operation has been successful in time, while laparoscopic surgery tends to prevail in the last decade in the right cases and properly equipped medical centers. The current review presents contemporary data on the diagnosis and treatment of bezoars through the Greek, English and French literature, also comparing them with well-established techniques and methods. [ABSTRACT FROM AUTHOR]

Big bezoars are rare foreign bodies of the stomach. In the literature, the problem of bezoars has been described mainly as isolated clinical cases. In this publication we present a case of endoscopic removal of a big bezoar, along with the diagnostics and treatment of concomitant erosive and ulcerative lesions, as well as detection of a gastric malignancy (tubular adenoma with severely dysplastic foci). The active endoscopic approach allowed for a timely preparation of the patient for a reconstructive surgery on the low extremity vasculature. The paper may be of interest for internists, gastroenterologists, surgeons, providing them with a motivation to perform a regular follow up of upper gastrointestinal tract in patients after surgical interventions on the stomach and duodenum. This clinical observation is a good example for endoscopists of a successful diagnostics and treatment of a rare comorbid disorder.

The purpose of this study was to characterise the radiographic appearance of abomasal phytobezoars in sheep as well as to evaluate the utility of abdominal radiography to identify them. Twenty-seven fat-tailed Herrick sheep with a clinical suspicion of abomasal impaction were examined radiographically. Abdominal survey radiographs in right lateral recumbency were taken. Abomasal phytobezoars (AP) were seen in abdominal survey radiographs in 25/27 sheep (92%). Their radiographic survey appearance was round-to-oval masses with radiopaque margins and radiopacity similar to the ingesta centrally. An additional gastrographic barium study was performed in six of the sheep, followed by exploratory laparotomy where phytobezoars were removed through abomasotomy. The optimal time to visualise the APs was 48 h post-contrast. A significant correlation was noted between phytobezoars size in radiology and surgery (r = 0.651, P < 0.001). Use of the barium study can improve the phytobezoar-ingesta contrast and visibility of the phytobezoars. Plain radiography with sheep positioned in right lateral recumbency is a useful supplementary technique which can be used to evaluate abomasal phytobezoariasis. This study shows that radiography is a suitable diagnostic method for detecting the presence of, but not the number of, abomasal phytobezoars in sheep.

Seed bezoars are a subcategory of phytobezoars, caused by consumption of indigestible vegetable or fruit seeds. We present the case of a 64-year-old male patient, who presented at the Emergency Department, complaining of constipation, tenesmus and rectal pain. History and digital examination revealed a rectal seed bezoar due to sunflower seeds, impacted in the lower rectum. The patient underwent manual disimpaction under general anaesthesia, after conservative measures failed. Seed bezoars represent a different pathophysiological process compared to fibre bezoars. They are usually found in the rectum of patients without predisposing factors, causing constipation and anorectal pain. History taking and digital rectal examination are the cornerstones of diagnosis, with manual disimpaction under general anaesthesia being the procedure of choice.

Bezoars are the rarest causes of upper abdominal masses and upper gastric outlet obstruction in children and are most commonly seen in females of adolescent age. They can present with the common symptoms of abdominal mass or abdominal pain but may lead to serious complications as well. They must be diagnosed and managed early despite their rarity so as to prevent complications like obstruction, perforation and bleeding. This article is reporting our 25 years experience with abdominal bezoars with variable presentation in our tertiary care centre.

Saba senegalensis (SS) is a well-known and commonly eaten fruit in Western Africa, especially in the rainy season when it is abundant. The ingestion of its seeds may cause abdominal pain and bowel obstruction. This cause might not be recognized by radiologists who are not aware of SS CT features. We thus present the characteristic CT features of SS as found in patients presenting with abdominal pain and incidentally in others. We also discuss the differential diagnosis with the cowries (ornament) and other similar fruits as imaged on CT.

• Phytobezoar is described as an impacted indigested or incompletely digested vegetable and fruit fibers. • Bezoar is a rare cause of gastric outlet obstruction. Being multiple and giant is even rarer. • The aim of this study is to report a case of unusual gastric outlet obstruction by two giant bezoars. Phytobezoar which is described as an undigested or incompletely digested food. It is an odd cause of gastric outlet obstruction (GOO). The aim of this study is to present and discuss a case of GOO caused by multiple giant bezoars. A 24-year-old female, presented with abdominal pain and vomiting (non-bilious) with negative past history. Examination and investigations revealed multiple giant bezoars requiring emergent surgical intervention. An exploratory laparotomy was conducted. Two giant bezoars were palpated in the stomach and removed through an anterior gastrotomy. Bezoars are regarded as rare benign causes of GOO. Bezoars can present with vomiting, nausea, and/or symptoms of GOO. Predisposing risk factors include delayed gastric emptying (as in case of diabetic mellitus) vagotomy, partial gastrectomy pyloroplasty, peptic ulcer disease, chronic gastritis, Crohn's disease, and carcinoma of the gastrointestinal tract. The current case had phytobezoar without any known risk factor. GOO caused by phytobezoar can occur in patients without history of previous gastric surgery or diabetes mellitus. Urgent laparotomy may be indicated. [ABSTRACT FROM AUTHOR]

Seed bezoars are a subcategory of phytobezoars, caused by consumption of indigestible vegetable or fruit seeds. We present the case of a 64-yearold male patient, who presented at the Emergency Department, complaining of constipation, tenesmus and rectal pain. History and digital examination revealed a rectal seed bezoar due to sunflower seeds, impacted in the lower rectum. The patient underwent manual disimpaction under general anaesthesia, after conservative measures failed. Seed bezoars represent a different pathophysiological process compared to fibre bezoars. They are usually found in the rectum of patients without predisposing factors, causing constipation and anorectal pain. History taking and digital rectal examination are the cornerstones of diagnosis, with manual disimpaction under general anaesthesia being the procedure of choice. [ABSTRACT FROM AUTHOR]

Afferent loop obstruction (ALO) can occur as a complication of gastrectomy with Billroth II or Roux-en-Y reconstruction. Conventionally, emergent surgery was performed for most cases, while endoscopic procedures for elective cases have been reported more recently. We report a unique case of ALO caused by a phytobezoar that was successfully treated by endoscopic procedures. A 76-year-old female patient presented with epigastric pain for several hours after dinner. The patient had a history of distal gastrectomy with Roux-Y reconstruction for gastric cancer at age 62. Computed tomography (CT) demonstrated evident dilation of the duodenum and common bile duct, and detected a bezoar at the jejunojujunal anastomosis site, indicating that the ALO was induced by the bezoar. Upper endoscopy visualized undigested food formation stuck at the anastomosis site, and it was successfully dislodged by endoscopic fragmentation using biopsy forceps. After the procedure, the abdominal symptoms subsided, and the patient was discharged on the fourth day. Bezoar-induced ALO is rare. In this case, CT helped diagnose the ALO induced by the bezoar. In recent times, there has been a rise in endoscopic interventions for ALO, and there are some reports of bezoar-induced small bowel obstruction being treated endoscopically. Therefore, a subsequent endoscopic examination was performed, confirming the presence of a phytobezoar and leading to a less invasive endoscopic fragmentation treatment in this case. This is a unique case report of phytobezoar-induced ALO treated by endoscopic fragmentation of undigested food, providing a beneficial treatment option. • A 76-year-old female patient was diagnosed with afferent loop obstruction caused by a phytobezoar. • Upper endoscopy revealed undigested food formation stuck at the jejunojejunal anastomosis site. The phytobezoar was successfully dislodged using endoscopic forceps. • This is a unique case of phytobezoar-induced afferent loop obstruction treated by endoscopic fragmentation. This provides valuable knowledge regarding the choice of less invasive treatments. [ABSTRACT FROM AUTHOR]

Bezoars are masses formed by the concretion of stomach contents or debris within the gastrointestinal tract. Bezoars are rare and account for only 0.4–4% of all cases of gastrointestinal obstruction and mainly occur in the stomach or small intestine. Intestinal obstruction caused by colonic bezoars is extremely rare. A 39-year-old man with a transplanted kidney came to the hospital because of abdominal pain, constipation, and distension. We performed an abdominal computed tomography scan and found an ovoid intraluminal mass with a mottled gas pattern in the distal sigmoid colon. Subsequently, the patient underwent laparotomic surgery and removal of the bezoar. We report a rare case of large bowel obstruction due to colonic phytobezoar, which was confirmed intraoperatively.

We describe a giant gastric phytobezoar in a child with repaired congenital esophageal atresia. At age two, a gastric interposition (pull-up) procedure was performed for severe and recurrent esophageal strictures. For 12 months post-gastric interposition, he experienced frequent respiratory illnesses requiring hospital admissions but it was not initially appreciated that these episodes were likely secondary to recurrent aspiration from a gastric bezoar with “spill-over” aspiration.

Introduction Meckel’s diverticulum is the most common anomaly of the gastrointestinal tract, occurring in 1–3% of the general population. The most common complication of Meckel’s diverticulum is intestinal obstruction. In this report, we describe a rare cause of intestinal obstruction due to Meckel’s; the phytobezoar. After thorough literature review, the authors found about ten individual reports of the same topic. In all these cases, diagnosis was established intra-operatively. Case presentation A forty-seven-year old male presented to the emergency department with a one-day history of abdominal pain associated with vomiting and constipation. Physical examination diagnostic tests revealed features of intestinal obstruction. Discussion The lifetime risk of complications in patients with a Meckel’sdiverticulum is usually small and occurs only in up to 4%. In adults’ intestinal obstruction is the most common complication (40%). Conclusion Complicated Meckel’s diverticulum can have different clinical presentations and can cause bowel obstruction. An association with bezoars impaction is possible and it should be suspected in adult patients presenting with bowel obstruction of unknown causes especially those with high vegetarian diet. [ABSTRACT FROM AUTHOR]

Nerium oleander is a plant containing cardiac glycosides, and intoxication with its leaves is a medical emergency. We report the case of a 73-year-old man who took a decoction of oleander leaves for a reckless purpose. Upon arrival in the emergency room, he presented an altered state of consciousness, drooling and vomiting. He was bradycardic with intermittent third-degree atrioventricular block and typical downsloping ST-segment depression related to glycosides toxicity. Despite initial treatment with atropine, isoprenaline and repeated bolus of digoxin-specific antibody (Fab) fragments, symptoms were persistent 12 hours after admission. Suspecting that the patient not only drank the decoction but also ingested the leaves and had slow gastric emptying, we performed gastric lavage without benefit. We subsequently performed a gastroscopy that showed an oleander phytobezoar, and its removal permitted a rapid clinical improvement. Treatment with digoxin-specific antibodies for intoxication is well described and dosage should be adapted to the plasmatic level. Such an examination is useless in oleander intoxication because it does not represent the real quantity of toxin. The dosage of antibodies is empiric and should be guided by the clinical severity. In such intoxication, the presence of a phytobezoar from oleander leaves cannot be excluded so we believe that a gastroscopy for its mechanical removal should always be considered to avoid persistent release of toxin., Learning Points: Ingestion of any part of the oleander plant can result in a severe cardioactive glycoside intoxication with potentially fatal arrhythmia and should be considered a medical emergency.Treatment consists of supportive care, correction of arrhythmias and electrolyte imbalance, and digoxin-specific antibody (Fab) fragments administration.Gastroscopy for mechanical removal of a phytobezoar responsible of persistent toxin release should be always considered., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2023.)

A 45-year-old woman was under study for one year of abdominal pain associated with 4kg weight loss and chronic constipation. An entero magnetic resonance found a mass of 8x10cm on medium ileum suggesting a phytobezoar, with no proximal bowel dilatation. The woman was scheduled for programmed resection. Two weeks after, she presented on our emergency department with an acute abdomen. Exploratory laparotomy showed a bowel perforation of the phytobezoar, and a segmental resection was performed. No more bezoars were found on exploration. She did well after surgery and was discharged home on 6th post-operative day. Pathology revealed a MALT Lymphoma (cells were CD20-positive B-lymphocytes that co-expressed BCL-2 and were negative for CD3, CD5, CD10, CD23, BCL-6 and cyclin D1 on immunohistochemical studies). The overall proliferation index was low with Ki-67 immunoreactivity in approximately 10% of cells. The bone marrow biopsy showed no evidence of involvement by lymphoma. The patient started therapy with rituximab infusions (monoclonal antibody against CD20). In two years follow up she remains asymptomatic and without recurrence. Primary ileal MALT lymphoma is rare, and has not been associated with a specific infectious disease. Bezoar is an unusual cause of small bowel obstruction accounting for 0.4-4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum. We believe that the primary MALT lymphoma caused a small mechanic obstacle that made alimentary fibers to accumulate and cause the phytobezoar. The perforation required a segmental resection, which finally led to the diagnostic of the MALT lymphoma.

Meckel’s diverticulum is a common anomaly of the gastrointestinal tract. The most common complications of Meckel’s diverticulum are inflammation, bleeding and obstruction. We present a 12-year-old boy with bowel obstruction due to phytobezoar in a Meckel’s diverticulum. We describe diagnostic difficulties and our surgery approach comparing it to the literature.