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      How could such a wide piece of tree root pass through the narrow pyloric orifice? An extremely rare case


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          Patient: Female, 30

          Final Diagnosis: Phytobezoar

          Symptoms: Nausea • vomiting

          Medication: —

          Clinical Procedure: —

          Specialty: —


          Rare disease


          Phytobezoars are a common type of bezoar known to accumulate in the gastrointestinal system.

          Case Report:

          A 30-year-old mentally retarded woman was operated on due to small bowel obstruction. A piece of tree root was extracted from the ileum. The patient was discharged from the hospital on postoperative day 7.


          Due to difficulties in determining the nature of the bezoar preoperatively, small bowel obstruction due to a phytobezoar is not a common diagnosis. For bezoars, prevention is considered preferable to treatment.

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          Most cited references 11

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          Bezoars: classification, pathophysiology, and treatment.

           C Andrus,  J Ponsky (1988)
          Bezoars, accumulations of foreign material in the stomach, have been known to occur in animals and man for centuries. The incidence of bezoars in human patients has increased as a result of operative manipulation of the gastrointestinal tract. Composed of vegetable matter, hair, or more unusual materials like shellac or cement, they may lead to anorexia, weight loss, bleeding, obstruction, or perforation of the alimentary tract. Although this entity is often recognized radiologically, endoscopy provides the most accurate means for identification and classification. Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Physicians must learn to recognize and classify bezoars correctly in order to provide the most appropriate therapy in each instance.
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            Gastrointestinal bezoars: sonographic and CT characteristics.

            The purpose of this study was to assess the value of imaging studies--conventional abdominal radiographs, sonography, and CT--in the diagnosis of gastrointestinal bezoars. A review was made of the radiologic findings of 17 consecutive patients with surgically verified gastrointestinal bezoars over a period of 51 months. Twelve patients had a history of previous gastric surgery. In no patient was a bezoar clinically suspected. Phytobezoars were recorded in 16 patients and a trichobezoar in only one. A total of 33 bezoars were identified at surgery. Two patients had isolated gastric bezoars, whereas 15 patients had bezoars located in the small bowel. Among the latter group, associated gastric bezoars were found in eight patients, and five patients had multiple intestinal bezoars. Abdominal radiographs revealed bezoars in three patients, sonography revealed bezoars in 15, and CT revealed bezoars in all 17. Seven patients had associated gastric bezoars revealed at CT versus only two patients with gastric bezoars revealed at sonography. CT revealed multiple intestinal bezoars in five patients whereas sonography revealed them in only two patients. Both sonography and CT are reliable methods for diagnosing gastrointestinal bezoars. CT is more accurate, however, and exhibits a quite characteristic bezoar image; in addition, this imaging technique is able to reveal the presence of additional gastrointestinal bezoars.
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              Is Open Access

              Diospyrobezoar as a Cause of Small Bowel Obstruction

              Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.

                Author and article information

                Am J Case Rep
                Am J Case Rep
                The American Journal of Case Reports
                International Scientific Literature, Inc.
                30 June 2014
                : 15
                : 284-287
                [1 ]Department of General Surgery, Erzincan University, Erzincan, Turkey
                [2 ]Department of Pathology, Erzincan University, Erzincan, Turkey
                [3 ]Department of General Surgery, Yunak State Hospital, Konya, Turkey
                [4 ]Department of Radiology, Erzincan University, Erzincan, Turkey
                Author notes

                Authors’ Contribution:


                Study Design


                Data Collection


                Statistical Analysis


                Data Interpretation


                Manuscript Preparation


                Literature Search


                Funds Collection

                This manuscript was accepted as an oral presentation at WCAS 2013

                Conflict of interest: None declared

                Corresponding Author: Arda Işik, e-mail: kararda@ 123456yahoo.com
                © Am J Case Rep, 2014

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License


                bezoars, general surgery, ileus, mentally disabled persons


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