Small bowel obstruction due to dried fruit and vegetable bezoars in paediatric patients of northern India.

Introduction: Many foods have been implicated in bezoar obstruction especially sun dried apricots, peaches, and prunes. Dried fruits and vegetable being hygroscopic imbibe water, swell in size and cause mechanical small bowel obstruction. We hereby submit our experience of dealing with patients who presented with acute small bowel obstruction (ASBO) due to dried phytobezoars. Materials and methods: This was a retrospective study which was conducted from March 2017 to March 2012. Operative records of the patients with ASBO due to phytobezoars were retrieved from Hospital Records Section. The clinical details, investigative work up, operative findings and intervention and type of bezoars were noted. Results: Over the period of 5 years, 12 patients of phytobezoars were admitted in the department. The mean age of the patients was 1.85 years with 7(58.3%) males and 5 females (41.6.5%). Vomiting was most common and was present in all the patients, bilious in 11 (91.7%). The other features included abdominal pain in 10 (83.3%), abdominal distension in 8 (66.7%), failure to pass stools in 9 (75%), failure to pass flatus in 9 (75%), diarrhoea 16 (25%), bleeding per rectum 2 (16.6% patients). All the patients were operated in emergency settings within the period of 8 ± 3 hours of admission. There were no significant operative complications and average hospital stay was 5.2±1 days. Conclusion: Dry fruits and vegetables like apricot, turnip and peach can lead to bezoar formation which subsequently leads to acute small bowel obstruction in these infants and young children. We also want to impress upon the treating physicians to keep in mind the probability of phytobezoars obstruction in patients presenting with mechanical ASBO especially in patients from Himalayan regions.

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Phytobezoar induced small bowel obstruction: an uncommon cause of intestinal occlusion

International Surgery Journal ◽

10.18203/2349-2902.isj20201886 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1648

Author(s):

Savas P. Deftereos ◽

Eleni I. Effraimidou ◽

Soultana Foutzitzi ◽

Panagiota Cristodoulou ◽

Maria Aggelidou ◽

...

Keyword(s):

Computed Tomography ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Subtotal Gastrectomy ◽

First Feeding ◽

Ultrasound Findings ◽

History Of ◽

Acute Small Bowel Obstruction ◽

Operative Findings

A case of a 42-year-old female patient with a two-days diffuse colicky abdominal pain, nausea and three episodes of vomiting is presented. Furthermore, patient complained for inability to eat for almost a week. In addition, patient had a history of subtotal gastrectomy Billroth II-type, due to gastric ulcer six years ago. There were no other known co-morbidities. Except for a distended, somewhat painful abdomen and sluggish bowel sounds, the rest clinical examination was unremarkable. Plain abdominal X-ray and ultrasound findings agreed with the clinical suspicion of sub-acute small bowel obstruction probably due to post-operative adhesions. A conservative management was decided. However, the patient after an initial clinical improvement, had a relapse of symptoms with the first feeding attempt. A followed computed tomography of the abdomen revealed a well define, oval, mass-like containing mostly air bubbles lesion, occupying for approximately six centimeters long the jejunum lumen. The diagnosis of jejunal phytobezoar was set. In accordance of computed tomography diagnosis were the intra-operative findings and the post-operative histopathology.

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Acute small bowel obstruction in a girl, caused by a jejunal bezoar composed of textile fibers

Journal of Pediatric Surgery Case Reports ◽

10.1016/j.epsc.2013.05.017 ◽

2013 ◽

Vol 1 (8) ◽

pp. 192-193

Author(s):

S. Zwaveling ◽

D.C. van der Zee

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Textile Fibers ◽

Acute Small Bowel Obstruction

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Jewish Holiday “Tu Bishvat” or Two Cases of Small Bowel Obstruction with Dried Apricot

Annals of Surgery and Perioperative Care ◽

10.26420/annsurgperiopercare.2021.1047 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Kukeev I ◽

◽

Replyansky I ◽

Czeiger D ◽

Atias S ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Gastric Bypass Surgery ◽

Surgical Removal ◽

Cellulose Content ◽

Lead Point ◽

First Case ◽

Dried Fruit ◽

High Level

Introduction: Small bowel obstruction caused by bezoars is rare. One of the causes of phytobezoars is dried fruits. We present two cases of small bowel obstruction caused by dried apricots during Jewish holiday “Tu BiShvat”. Case Presentation: Two men, 54 and 86 years old hospitalized with acute abdomen attributed to small bowel obstruction. In the first case - intoxicated patient, due to suspicion of mesenteric ischemia underwent laparotomy. A lead point caused obstruction was found and after enterotomy whole dried apricot was removed. The patient swallowed it whole three days before hospitalization. In the second case, edentulous patient with small bowel obstruction and peritonitis underwent laparotomy. The cause of obstruction was a dried apricot swallowed whole by the patient. Discussion: Presentation of bezoar with features of acute surgical abdomen is extremely rare, accounting for only 1% of the patients. The expansion of phytobezoar that is high in cellulose content can absorb a large amount of fluid causing an obstruction of the small bowel. The treatment of small bowel obstruction caused by bezoars varies from dissolving with cellulase, papain and even Coca-Cola, followed by endoscopic and surgical removal. Conclusion: A high level of suspicion needs to exist in the presence of a history of eating dried fruit, which can cause gastrointestinal obstruction. Especially on background gastric bypass surgery and inadequate mastication.

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