Amlookobezoar; a diospyrobezoar causing acute small bowel obstruction-A case series

Document Type : Case Report

Authors

Department of General Surgery, Government Medical College, Rajouri India.

Abstract

Abstract:
Introduction: Bezoars are non-dissolved hard masses of undigested or partially digested food or foreign material that are trapped in the gastrointestinal tract. Bezoars are broadly classified into four groups, viz; phytobezoars, trichobezoar, lactobezoars, and pharmacobezoars. One of the common sub-types of phytobezoars is amlookobezoar (diospyrobezoar).
Aims: To describe the clinical profile and treatment outcome of a series of patients of amlookobezoar presenting with small bowel obstruction.
Methods: This prospective observational case-series study includes five patients of both sexes presenting with small bowel obstruction (SBO) caused due to amlookobezoar. All patients were evaluated with respect to detailed history, physical examination and radiological assessment to confirm the diagnosis. Radiological assessment included X-ray abdomen, USG and CECT abdomen.
Results: We had total of five cases of SBO caused due to amlookobezoars. The age of these patients ranged from 8-years to 22-years with male-female ratio of 4:1. All the 5 patients in this series presented with the features of SBO in the autumn months. None of our patients had any other significant predisposing factor for bezoar formation except that all of these patients had taken significant amount of amlooks (persimmon fruit) 3-10days earlier. Four patients eventually required the exploratory laparotomy. All the four patients had soft to firm bezoars stuck up in distal or mid-ileum. Fortunately in all these 4 patients, we were able to manually breakdown the amlookobezoars and milk them down beyond the ileocaecal level without the need for any enterotomy, gut resection or creation of stoma. In all of the 4 operated patients, the postoperative period was almost uneventful.
Conclusion: Though uncommon, but amlookobezoars should be considered as differential diagnosis in a case of small bowel obstruction. Amlookobezoars commonly affects young adolescent males in the autumn months and often needs a laparotomy with fragmentation and milking down of amlookobezoars.

Keywords

References

  1. Mohammadi A, Mojtahedzadeh M, Ahmadi A, Imanipour MH, Saghafi F, Soltaninejad S, et al. Bowel
    Obstruction Caused by Persimmon Phytobezoars: A Case Report. International Journal of Medical
    Toxicology and Forensic Medicine. 2021;11(3):32507.
  2. Ahmed M, Habis S, Mahmoud A, Saeed R, Elkahly M. Surgical Removal of Numerous Foreign Body
    Gastric Bezoar: A Case Report. Cureus. 2019;11(3):e4173.
  3. Harper D. Bezoar "bezoar". Online Etymology Dictionary.
  4. Gonuguntla V, Joshi DD. Rapunzel syndrome: a comprehensive review of an unusual case of trichobezoar.
    Clinical medicine & research. 2009;7(3):99-102.
  5. Hewitt AN, Levine MS, Rubesin SE, Laufer I. Gastric bezoars: reassessment of clinical and radiographic findings
    in 19 patients. The British journal of radiology. 2009;82(983):901-7.
  6. Sumskiene J, Janciauskas D, Pilkauskaite G, Kristalnyj V, Kupcinskas L. An unusual case of bleeding from stomach due to a giant diospyrobezoar. Medicina (Kaunas, Lithuania). 2009;45(6):476-9.
  7. Malhotra A, Jones L, Drugas G. Simultaneous gastric and small intestinal trichobezoars. Pediatric
    emergency care. 2008;24(11):774-6.
  8. Buckley NA, Dawson AH, Reith DA. Controlled Release Drugs in Overdose. Drug Safety. 1995;12(1):73-84.
  9. Serour F, Dona G, Kaufman M, Weisberg D, Krispin M. [Acute intestinal occlusion caused by phytobezoar in Israel. Role of oranges and persimmons]. Journal de chirurgie. 1985;122(5):299-304.
  10. de Toledo AP, Rodrigues FH, Rodrigues MR, Sato DT, Nonose R, Nascimento EF, et al. Diospyrobezoar
    as a cause of small bowel obstruction. Case reports in gastroenterology. 2012;6(3):596-603.
  11. Zhang RL, Yang ZL, Fan BG. Huge gastric disopyrobezoar: a case report and review of literatures.
    World journal of gastroenterology. 2008;14(1):152-4.
  12. Gayà J, Barranco L, Llompart A, Reyes J, Obrador A. Persimmon bezoars: a successful combined
    therapy. Gastrointestinal endoscopy. 2002;55(4):581-3.
  13. Krausz MM, Moriel EZ, Ayalon A, Pode D, Durst AL. Surgical aspects of gastrointestinal persimmon phytobezoar treatment. American journal of surgery. 1986;152(5):526-30.
  14. Kaushik NK, Sharma, Y.P., Negi, A. and Jaswal, A. Images-gastric trichobezoar. Indian Journal of Radiology and Imaging. 1999(9):137-9.
  15. Yakan S, Sirinocak A, Telciler KE, Tekeli MT, Deneçli AG. A rare cause of acute abdomen: small bowel
    obstruction due to phytobezoar. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma
    & emergency surgery : TJTES. 2010;16(5):459-63.
  16. Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surgical endoscopy. 2007;21(11):1945-9.
  17. Tayeb M, Khan FM, Rauf F, Khan MM. Phytobezoar in a jejunal diverticulum as a cause of small bowel
    obstruction: a case report. Journal of Medical Case Reports. 2011;5(1):482.
  18. Chisholm EM, Leong HT, Chung SC, Li AK. Phytobezoar: an uncommon cause of small bowel obstruction. Annals of the Royal College of Surgeons of England.1992;74(5):342-4.
  19. Robles R, Parrilla P, Escamilla C, Lujan JA, Torralba JA, Liron R, et al. Gastrointestinal bezoars. 1994;81(7):1000-1.
  20. Ahn YH, Maturu P, Steinheber FU, Goldman JM. Association of diabetes mellitus with gastric bezoar
    formation. Archives of internal medicine. 1987;147(3):527-8.
  21. Yamamoto M, Yamamoto K, Bian X, Guo Q, Sasaki T, Yamamoto F, et al. Small Bowel Obstruction Caused by
    Dried Persimmon. Case reports in gastroenterology. 2018;12(1):147-52.
  22. Funamizu N, Kumamoto T, Watanabe A, Okamoto T, Yanaga K. Intestinal Obstruction Caused by Persimmon
    Bezoar: A Case Report. International Surgery. 2015;100:1194-8.
  23. Ha SS, Lee HS, Jung MK, Jeon SW, Cho CM, Kim SK, et al. Acute intestinal obstruction caused by
    a persimmon phytobezoar after dissolution therapy with Coca-Cola. The Korean journal of internal
    medicine. 2007;22(4):300-3.
  24. Teng TZJ, Tan YP, Shelat VG. Persimmon fruit causing simultaneous small bowel and stomach obstruction.
    Singapore medical journal. 2019;60(10):550.
  25. E R T A S M YA A T T C İ E . Diospyrobezoar in Jejunum Causing Intestinal Obstruction: A Rare Case
    Report Duzce Medical Journal. 2005;7(2):29 - 32.
  26. Raheel Hussan Naqvi* AG, Bhanu Khokher, Surbhi Dhar, Shaarang Gupta. Prospect of food bolus
    obstruction in a tertiary care hospital. international Surgery Journa. 2022;9(9):1572-6.
Iranian Journal of Colorectal Research
Volume 10, Issue 4
December 2022
Pages 174-179

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