A rare cause of acute abdomen: small bowel obstruction due to phytobezoar

Abstract

Background: Phytobezoars are a rare cause of acute small bowel obstruction. The aim of this work was to identify the diagnostic difficulties and treatment of this rare entity.

Methods: Data of 14 patients operated between January 1999-January 2009 with small bowel phytobezoar were retrospectively studied. The patients (n=432) were treated in our clinic for small bowel obstructions. Of these, 14 (3.2%) phytobezoar-induced small bowel obstructions were included in this series. Median patient age was 57.25 years; nine (64%) of the patients were male, and five (36%) were female.

Results: The predisposing factor was previous gastric surgery in 12 (87.5%) patients and previous abdominal surgery and total absence of the teeth in two (14.3%) patients. A completely obstructing terminal ileal phytobezoar was found in nine (64%) patients and jejunal phytobezoar in five (36%) patients during exploration. There was no mortality.

Conclusion: Phytobezoar-induced small bowel obstruction remains an uncommon diagnosis that poses a diagnostic and management challenge. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, poor dentition or a history suggestive of increased fiber intake.