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Gastrointestinal phytobezoar in children
1Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Insights
Gastrointestinal phytobezoars, often caused by persimmon ingestion in children, can lead to obstruction. Surgical intervention and thorough examination are crucial for effective treatment and prevention of recurrence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Digestive Diseases
Background:
- Phytobezoars, formed from undigested plant matter, are the most common cause of bezoar-related gastrointestinal obstruction.
- Children are susceptible to phytobezoar formation, particularly after consuming fruits like persimmons.
Purpose of the Study:
- To analyze cases of pediatric gastrointestinal phytobezoars.
- To identify common causes, locations, and effective treatment strategies for phytobezoars in children.
Main Methods:
- Retrospective analysis of 11 pediatric gastrointestinal phytobezoar cases over 8 years (1981-1988).
- Review of patient history, symptom onset, dietary factors (especially persimmon ingestion), bezoar location, and surgical interventions.
Main Results:
- Persimmon ingestion was linked to symptoms in 6 out of 11 pediatric patients.
- Most cases occurred in late fall and winter; common locations included the ileum and jejunum.
- Emergency laparotomy was performed for intestinal obstruction, with fragmentation and surgical manipulation as primary treatments.
Conclusions:
- Persimmon consumption is a significant risk factor for pediatric phytobezoar formation.
- A detailed dietary history is vital for preoperative diagnosis.
- Comprehensive intraoperative examination of the gastrointestinal tract is essential to prevent recurrent obstruction.
Abstract:
Phytobezoars are composed of fruit or vegetable matter, including seeds, nuts, and pits, and are the most common type of bezoar associated with gastrointestinal obstruction. Eleven gastrointestinal phytobezoar in children (less than 15 years old) seen within a period of 8 years (1981-1988) were analysed. Six were boys and 5 were girls. On history, 6 patients developed symptoms after ingestion of persimmon. All cases except one occurred in late fall and winter. In 8 patients, phytobezoar was found in a single location with 5 in the ileum and 3 in the jejunum. Multiple locations were found in 3 patients. Emergency laparotomy was performed on all cases who had typical mechanical intestinal obstruction. Treatment consisted of fragmentation of bezoar with pushing toward the cecum in 9 patients, combined with gastrotomy in 3 patients, and enterotomy in 2 patients. Because the persimmon ingestion is the most common cause of bezoar formation, a careful dietary history will usually suggest the diagnosis preoperatively. All the gastrointestinal tract should be thoroughly examined intraoperatively, especially the stomach and terminal ileum, to prevent another intestinal obstruction caused by an undiscovered phytobezoar.