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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.

Aim: To analyze efficacy of endoscopic lithotripsy combined with drug lithotripsy as compared with drug lithotripsy for the treatment of phytobezoars. Methods: We collected and evaluated case records of 165 patients with phytobezoars from 2014 to 2023. And we analyzed demographic and clinical characteristics, imaging features, endoscopic features, complications of phytobezoars, and compared efficacy between endoscopic lithotripsy combined with drug lithotripsy (Group A) and drug lithotripsy (sodium bicarbonate combined with proton pump inhibitor) (Group B). Results: The median age of patients with phytobezoars was 67.84 ± 4.286 years old. Abdominal pain was the most common symptom and peptic ulcers (67.5%) were the most common complication. Bezoar-induced ulcers were more frequent in the gastric angle. The success rate of phytobezoars vanishing in Group A and Group B were similar (92.3% vs. 85.1% within 48 h, 98.7% vs. 97.7% within a week), while the average hospitalization period, average hospitalization cost, second endoscopy rate, and average endoscopic operation time were significantly lower in patients in Group B than in Group A. Conclusion: Drug lithotripsy is the preferred effective and safe treatment option for phytobezoars. We advise that an endoscopy should be completed after 48 h for drug lithotripsy. [ABSTRACT FROM AUTHOR]

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]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

Aim: We aimed to evaluate our phytobezoar cases who were followed up and treated due to mechanical obstruction in our clinic. Materials and Methods: The fles of acute abdomen or ileus patients who were followed up in the Elazığ Training and Research Hospital General Surgery Clinic between January 2013 and January 2018 were evaluated retrospectively. Patients whose data were not available and who were followed up and treated for non-phytobezoar ileus and acute abdomen were excluded from the study. Nine patients meeting the inclusion criteria were reviewed retrospectively. Demographic data (age, gender) of the patients, previous surgical histories, comorbidites, whether there is gastric or intestinal bezoar, treatment options and complications were recorded. Numerical data are given as median (minimum - maximum values); categorical data are given as n (%) for statistical evaluation. Results: Three of the patients were female (33.4%) and 6 were male (66.7%).The median age of all patients was 71(25--78) years. Seven of the patient had previous surgical intervention history (77.8%) (5 had gastric surgery and 2 had other abdominal surgery history), 2 (22.2%) had no previous surgical intervention history. Two of the patients (22.2%) whom endoscopic intervention was performed for with gastric bezoar, operated for intestinal obstruction due to migration of gastric bezoar.One of the patients (11.1%) whom had no surgical intervention history had primary intestinal bezoar and one (11.1%) had concomitant intestinal bezoar with gastric bezoar. Conclusion: Mechanical obstruciton due to bezoars, must be kept in mind in patients who had perivous gastric surgery history and habitual eating disorders.Not only the exploration of the target area but also whole exploration must be done.Close follow up for migration is important for the gastric bezoars after endoscopic interventions. [ABSTRACT FROM AUTHOR]

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.)

We presented a case of a 64-year-old female patient with a history of gastric bypass that presented with bowel obstruction due to a bezoar. She arrived at the emergency department, referring to severe abdominal pain, nausea, and vomiting. Abdominal X-ray reported gastric distention and hydro-air levels. CT scan reported swirling of the mesentery vessels and a collapsed intestinal loop, mimicking an internal hernia. Laparotomy was accomplished, which shows obstruction at 60 cm from the ileocecal valve. An enterolithotomy was performed, and a 6 × 6 cm phytobezoar was extracted. The patient had a satisfactory postoperative outcome, discharging her home on the fourth postoperative day. On a 12 month-follow up, the patient is doing well with no further complications. Gastric bypass continues to be one of the most performed bariatric procedures with low complication rates. It is important to note that not all intestinal obstructions in postoperative bariatric surgeries are due to internal hernias or adhesions. The differential diagnosis of intestinal obstruction due to bezoar must be present in patients who underwent bariatric surgery. Nutritional counseling is essential for the follow-up of patients, emphasizing fluid intake and slow chewing, as well as the use of absorbable materials for suture during the surgery. [ABSTRACT FROM AUTHOR]

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.

Summary: This report describes the treatment of a 17‐year‐old American Quarter Horse gelding for an oesophageal obstruction of approximately 24 h' duration. An intraluminal oesophageal mass resembling a phytobezoar and located close to the cardia, was observed during endoscopic examination of the oesophagus of a horse showing signs of oesophageal obstruction. An intrathoracic oesophageal diverticulum, filled with fluid, was observed about 40 cm proximal to the obstruction. The end of a nasogastric tube was guided beyond the diverticulum, using gastroscopic observation, so that its tip rested close to the obstruction. The obstruction failed to disintegrate or move into the stomach despite vigorous, prolonged lavage. With the nasogastric tube left in place, and the horse's head elevated, 0.5 L cola was administered adjacent to the obstruction through the nasogastric tube. The head was maintained in the elevated position for an hour, after which time the head was lowered and oesophageal lavage resumed. The nasogastric tube was passed into the stomach within 3 min of re‐instituting lavage. The successful use of a carbonated beverage to treat human patients for oesophageal or gastrointestinal obstruction caused by a phytobezoar is well documented. Carbonated beverages have also been reported to be effective in treating horses for gastric and enteric impactions caused by persimmon seeds. Administering cola into the oesophagus may help resolve oesophageal obstruction of horses caused by a phytobezoar or impacted feed material when horses are refractory to other treatments. [ABSTRACT FROM AUTHOR]

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.

Gastric bezoars occur in the stomach due to foreign body accumulation with an inability to pass through the pylorus. Major complications of bezoars include intestinal obstruction, gastric ulcer, gastric perforation, and bleeding. Many gastric bezoars can often be treated conservatively. Endoscopy has been commonly used in both the diagnosis and treatment of bezoars. We present a case that complained about abundant gastrointestinal bleeding as well as abdominal distension and was successfully treated with emergency gastric surgery after the failure of bleed control by endoscopic intervention due to giant gastric bezoar. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: Our aim was to evaluate the feasibility of using ultrasonography (US) in the detection and management of small bowel bezoars in elderly patients (> 65 y). Material and Methods: This study included 15 elderly patients (> 65 y) with small bowel obstruction and initial diagnosis of small bowel bezoar using abdominal computed tomography (CT) from among 182 patients with small bowel obstruction. The diagnostic performance of US was prospectively evaluated and compared with the surgical or clinical diagnoses. Results: Among the 15 patients, ten of them were diagnosed via ultrasonography as having small bowel bezoar. Eight patients were also surgically diagnosed with phytobezoars, and the remaining two patients who showed bezoars on US showed complete symptomatic improvement with ultrasonographic follow-up showing the bezoar passing through the cecum. The other five patients were surgically diagnosed with brid ileus. US correctly diagnosed small bowel bezoars in all patients. The sonographic follow-up of the bezoars in the two patients who showed symptomatic improvement was also successful. Conclusion: US is a feasible imaging modality for the diagnosis and follow-up of small bowel bezoars. Timely diagnosis and management of bezoars is especially important in elderly patients. US can help both, radiologists and clinicians in easy diagnosis and timely management of small bowel bezoars in elderly patients. [ABSTRACT FROM AUTHOR]

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]

Background: Bezoars are an infrequent aetiology of bowel obstruction after a laparoscopic Roux-en-Y gastric bypass (LRYGB). Objective: To describe a clinical case of bowel obstruction due to a phytobezoar in an uncommon site, in a patient 2 years after a LRYGB. Case Report: A female patient with a history of LRYGB 2 years ago and bowel obstruction due to phytobezoar. Discussion: Factors that can contribute to the formation of bezoar in this case and strategies for its prevention are discussed. The importance of the imaging study and timely surgical exploration is emphasized. [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]

Aim: The aim of the present study was to discuss the operated cases for bezoar and the treatment results in comparison to the literature. Material and Methods: We retrospectively reviewed 30 cases operated due to bezoar in our hospital from 2008 to 2017. Demographic characteristics, comorbidities, obstruction locations, dietary habits, clinical findings, diagnostic and therapeutic methods, and the outcomes of the patients were recorded from the patient files. Results: Thirty cases of bezoar were found. One patient was treated two times due to recurrence. The distribution of cases according to the monthly prevalence was observed as 4 patients in November, 10 patients in January, 9 patients in December, 3 patients in February (86.6% in autumn and winter). Twenty-one patients (70 %) had a history of abdominal surgery. Eighteen (% 60) patients also had gastric surgery. Surgery revealed 18 (%60) bezoar cases in the jejunum and ileum. Five (%16.6) patients had bezoars found concurrently in the stomach and ileum and in 7 patients (%23.3) had bezoars in the stomach. Fragmentation and milking were done to three patients, resection-anastomosis was performed to one patient, enterotomy was performed to 16 patients, gastroenterostomy was performed to 3 patients, enterotomy and gastrotomy were performed to 2 patients, gastrectomy was performed to one patient and gastrotomy was performed to 4 patients. The average days of patients stayed at the hospital were 12.83 ± 14.2 (6-84) days. Conclusion: IBO caused by bezoar is still a rare diagnosis. This case must be considered for intestinal bowel obstruction encountered in patients with previously undergone gastric surgery and fibrous food consumption, especially in autumn and winter months. [ABSTRACT FROM AUTHOR]

Bezoars are concretions of indigestible foreign materials that develop within the gastrointestinal (GI) tract. A variety of materials received orally may form these masses. According to their composition, bezoars are classified as phytobezoars, which are the most frequent, trichobezoars, pharmacobezoars, lactobezoars, and other more rare entities. They are formed most frequently in the stomach and they may trigger serious symptoms, including dysphagia, abdominal pain, hematemesis, and intestinal obstruction or perforation. Contrast-enhanced computerized tomography (CT), in conjunction with GI endoscopy, has contributed substantially to the prompt and accurate diagnosis of these masses. Endoscopy also offers reliable therapeutic options, either through chemical disintegration of the bezoars or mechanical fragmentation and removal. The more serious cases of intestinal bezoars are usually treated surgically, either laparoscopically or via traditional laparotomy. This series describes four cases of intestinal phytobezoars that caused small bowel obstruction, and, in one case perforation, and were all treated surgically. Current advances in the diagnosis and treatment of bezoars are discussed and compared with the well-established 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.

Case report of a phytobezoar causing gastric outlet obstruction as a late complication after biliopancreatic diversion with duodenal switch, review of the literature and discussion of bezoars as a differential diagnosis in patients after bariatric surgery presenting with signs of intestinal obstruction. [ABSTRACT FROM AUTHOR]

• 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]