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Small bowel phytobezoars: detection with radiography.

A G Verstandig1, B Klin, R A Bloom

  • 1Department of Radiology, Hadassah University Hospital, Ein Kerem, Jerusalem.

Radiology
|September 1, 1989
PubMed
Summary
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Radiographic findings in 19 patients reveal small bowel phytobezoars, often caused by gastric surgery or persimmon intake. Barium studies help differentiate bezoars from adhesions and detect gastric bezoars, crucial for preventing recurrent obstruction.

Area of Science:

  • Gastroenterology
  • Radiology
  • Surgical Pathology

Background:

  • Phytobezoars, particularly those in the small bowel, can cause significant gastrointestinal obstruction.
  • Predisposing factors include prior gastric surgery and dietary habits, such as persimmon consumption.

Purpose of the Study:

  • To review and analyze radiographic findings in patients diagnosed with small bowel phytobezoars.
  • To identify common causes and typical locations of small bowel phytobezoars.
  • To evaluate the utility of contrast-enhanced studies and barium enemas in diagnosing phytobezoars and differentiating them from other causes of obstruction.

Main Methods:

  • Retrospective review of radiographic findings in 19 patients with small bowel phytobezoars.
  • Analysis of contrast material-enhanced upper gastrointestinal tract studies (12 patients) and barium enema studies (1 patient).

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Main Results:

  • Most common predisposing factors identified were previous gastric outlet surgery and persimmon ingestion.
  • Radiographic studies revealed phytobezoars in the stomach (4), duodenum (2), and small bowel (8) across 10 patients.
  • Small bowel phytobezoar obstructions were frequently located in the jejunum or proximal ileum, more proximally than previously reported.
  • Barium studies proved effective in distinguishing bezoar-induced obstruction from postoperative adhesions and in detecting residual gastric bezoars.

Conclusions:

  • Small bowel phytobezoars often present with proximal obstruction, necessitating accurate diagnosis.
  • Radiographic imaging, particularly barium studies, is vital for differentiating bezoars from adhesions and identifying concurrent gastric bezoars.
  • Surgical intervention is often required, as bezoar obstruction typically does not respond to conservative management, and removal of gastric bezoars is essential to prevent recurrence.