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Small bowel obstruction in children due to persimmon phytobezoars
Arshad Zafar1, Sajjad Ahmad, Aamir Ghafoor
1Department of Surgery Unit-A, Ayub Medical College, Abbottabad, Pakistan. azafar@brain.net.pk
Objective:
To present the clinical picture of small bowel obstruction caused by Persimmon phytobezoars in children of Hazara (Northern Pakistan).
Design:
Descriptive case series.
Place And Duration Of Study:
Three general surgical units of Ayub Teaching Hospital, Abbottabad from November 1998 to March 2003.
Patients And Methods:
Nineteen children were managed for small bowel obstruction due to persimmon phytobezoars. The age, gender, season at the time of presentation, history of persimmon ingestion, symptoms, signs, site of obstruction, operative procedure and outcome were analyzed.
Results:
There were 15 males and 4 females with ages ranging from 4-11 years (mean 7 years). All presented in winter with a positive history of persimmon ingestion. All had signs and symptoms and evidence of small bowel obstruction on plain abdominal x-rays. At laparotomy, ileum was the commonest site of obstruction. Milking of bezoars into caecum was performed in 17 patients while 2 patients required enterotomy for removal of bezoars. Complications occurred in 4 patients. There was no mortality.
Conclusion:
Small bowel obstruction in children due to persimmon phytobezoars is uncommon. However, it should be considered pre-operatively as a possible cause of intestinal obstruction in winter in children who have access to the fruit. Laparotomy should be performed for persistent obstruction or signs of strangulation.