Discussing treatment strategies for acute mechanical intestinal obstruction caused by phytobezoar: A single-center retrospective study

Abstract

BACKGROUND: This study aims to discuss management strategies regarding phytobezoar induced ileus based upon clinical results. METHODS: In the present study, between December 2012 and December 2018, a total of 25 patients who were diagnosed with phytobezoar were evaluated retrospectively. Patients who had acute mechanical intestinal obstruction due to phytobezoars at different segments of gastrointestinal (GI) tract were included in this study. The clinical data (such as clinical findings, laboratory results, radiological evaluations, treatment methods) of the patients were examined. RESULTS: Twenty five patients were included in this study. Of the 25 patients, 13 were women (52%). The median age was 60 (31-84) years, and the overall median length of the stay was 7 (2-28) days. Previous abdominal surgery had been recorded for 13 patients (72%). Two patients (8%) were followed up conservatively, whereas 20 (80%) patients had needed surgical intervention. One (4%) patient underwent surgery for distal ileal obstruction due to the pieces of bezoar that crumbled with previous endoscopic intervention. Three of the patients had complications, such as surgical site infection, wound dehiscence and paralytic ileus in the postoperative period. There were no differences between milking and gastrotomy/enterotomy groups according to the length of stay and postoperative complications. One patient died on the 13 th postoperative day due to multi-organ failure. The mortality rate was 4%. CONCLUSION: Phytobezoars, which are common with many other different surgical entities, can be located at any segment of the gastrointestinal tract and may cause obstruction, strangulation and/or even perforation. Contrast-enhanced CT scan must be performed in case of suspicion and to rule out any other causes of acute mechanical intestinal obstruction. Conservative and endoscopic procedures may be useful for selected patients, but the surgical treatment may be needed for the vast majority of the patients with phytobezoar. The surgery is safe for phytobezoar if the enterotomy site is chosen wisely.

Clinical Characteristics and Treatment Outcomes Among Patients With Gastrointestinal Phytobezoars: A Single-Institution Retrospective Cohort Study in Korea

“…Nonetheless, gastric cancer remains the most common cancer in Korea, with an annual incidence rate of 57.9/100,000, and many patients still require gastric surgery ( 11 ). In accordance with previous findings, the most common predisposing risk factor identified in our study was previous gastric surgery (31.4% of patients) ( 7 , 8 , 14 , 17 ). However, most patients in these other studies had undergone surgical treatment for peptic ulcers ( 7 , 8 , 14 , 17 ), whereas 75% of our patients had undergone surgical treatment for gastric cancer.…”

“…In accordance with previous findings, the most common predisposing risk factor identified in our study was previous gastric surgery (31.4% of patients) ( 7 , 8 , 14 , 17 ). However, most patients in these other studies had undergone surgical treatment for peptic ulcers ( 7 , 8 , 14 , 17 ), whereas 75% of our patients had undergone surgical treatment for gastric cancer. The incidence of phytobezoars formation after gastric surgery ranges from 5 to 12% ( 5 , 8 ), highlighting the importance of regular evaluations after gastric surgery.…”

“…Widening of the gastric outlet via gastroenterostomy or pyloroplasty can easily lead to the passage of a large, non-fragmented bolus to the small intestine, resulting in downstream impaction. However, patients with peptic ulcers are now more commonly treated using conservative strategies ( 17 ). Nonetheless, gastric cancer remains the most common cancer in Korea, with an annual incidence rate of 57.9/100,000, and many patients still require gastric surgery ( 11 ).…”

“…In accordance with previous findings, most phytobezoars located in the stomach were easy to diagnose and have a high rate of successful removal via endoscopy. In contrast, phytobezoars that had migrated to the small intestine were difficult to diagnose and more likely to require surgery ( 7 , 13 , 17 , 18 ). Although all patients in the surgical treatment group underwent CT, only 72% were diagnosed with phytobezoars prior to surgery.…”

Food-Induced Duodenal Obstruction Successfully Reopened by Endoscopic Treatment

“…A case of jejunal ileus due to an impaction of shiitake mushrooms was reported, which was treated endoscopically using a snare to fragment the impaction [9], similar to our case. Other ileus cases induced by foreign bodies, such as gallstones, phytobezoars, and enteroliths, have also been reported [10][11][12]. Most of these cases required surgical treatment for disimpaction.…”