Treatment of phytobezoars: Tailoring management to diverse presentation

Abstract

Objective: A minimally invasive approach is feasible and successful for the treatment of phytobezoars. We would like to draw attention to the overconsumption of Sorbus domestica and discuss the management options of patients presenting with different symptoms due to phytobezoars. Material and Methods:Data from patients diagnosed with phytobezoars in the Department of General Surgery from 2010 to 2016 were prospectively collected and evaluated.Results: Twenty patients diagnosed with phytobezoars were included in the study. The etiology of phytobezoar was Sorbus domestica seeds in 12 patients, watermelon seeds in two patients, Japanese persimmon seeds in one patient, and unidentified in five patients. Fourteen patients underwent surgery, while the remaining patients were treated conservatively. Minimally invasive surgery was used in all but two cases, where the surgery was converted to laparotomy. Two patients developed postoperative morbidity. There was no mortality. Conclusion:The treatment modality should be selected for each patient according to the presenting symptoms and characteristics of phytobezoar. In cases where surgery is performed, a minimally invasive approach is feasible and successful for the treatment of ileus.

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars

“…Phytobezoars are composed of vegetable and/or fruit matter, such as celery, prune, apricots, grape skin, orange, raisin, watermelon, pumpkin, mushroom or persimmon. The main components of these indigestible food materials may be cellulose or hemicellulose, tannin and/or lignin [5,6].…”

Self-made wire loop snare successfully treats gastric persimmon stone under endoscopy

“…Treatment of plant-based gastroliths include stone dissolution, endoscopy, and surgery. Litholytic treatments include sodium bicarbonate solution and a variety of protease preparations that can soften, shrink or dissolve gastric stones as a single treatment, or as an auxiliary treatment before and after endoscopic treatment[ 13 ]. If drugs and endoscopy are not effective, patients need surgery.…”

“…The pieces are then taken out or discharged through the intestines. Some hospitals use lasers or high-frequency electric lithotripsy simultaneously[ 1 , 13 ]. We used self-made wire loop snares to crush the stones mechanically.…”

A case series of intestinal obstruction secondary to shiitake mushroom intake during Chinese New Year

“…Enterotomy with extirpation of the bezoar is usually performed and segmental resection may be needed in cases of bowel ischaemia or bowel wall necrosis resulting from the bezoar. Alternatively, crushing the phytobezoars and passing the contents through the caecum without enterotomy can also be performed [ 9 ]. Laparoscopic surgery is also increasingly performed for the treatment of phytobezoars.…”

“…Laparoscopic surgery is also increasingly performed for the treatment of phytobezoars. Zeki and Okan [ 9 ] reported successful laparoscopic surgery in 12 patients with two cases requiring conversion to laparotomy.…”