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

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.

Akut karýnýn nadir bir sebebi: Fitobezoara baðlý ince baðýrsak týkanýklýðý

AMAÇ
Fitobezoarlar akut ince baðýrsak týkanýklýðýnýn nadir sebeplerindendir. Bu çalýþmanýn amacý, bu nadir klinik durumun teþhis ve tedavisindeki zorluklarý incelemektir.
GEREÇ VE YÖNTEM
Ocak 1999 ile Ocak 2009 tarihleri arasýnda ameliyat edilen 14 fitobezoar olgusunun dosyalarý retrospektif olarak incelendi. Toplam 432 hasta ince baðýrsak týkanýklýðý nedeniyle kliniðimizde ameliyat edildi. Fitobezoara baðlý ince baðýrsak týkanýklýðý saptanan 14 (%3,2) olgu çalýþmamýza dahil edildi. Ortalama hasta yaþý 57,25 olup hastalarýn 9’u kadýn, 5’ide erkek idi.
BULGULAR
Predispozan faktörler arasýnda önceden gastrik cerrahi öyküsü 12 (%87,5) hastada, önceden abdominal cerrahi ve diþlerin tam yokluðu 2 (%14,3) hastada saptandý. Eksplorasyonda 9 hastada terminal ileumda, 5 hastada da jejunumda tam týkanýklýða yol açan fitobezoar saptandý. Mortalite gözlenmedi.
SONUÇ
Fitobezoara baðlý ince baðýrsak týkanýklýðý nadir görülen, tanýda ve tedavide zorluk yaþanýlan durumlardýr. Daha önceden gastrik operasyon geçirmiþ, fazla miktarda lifli gýda tüketimi ve diþsizlik gibi bezoar formasyonu için yüksek riskli durumu bulunan olgular ile karþýlaþýldýðýnda fitobezoar akla getirilmelidir.