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Gastrointestinal phytobezoars: presentation and management.

P G Hayes, O D Rotstein

    Canadian Journal of Surgery. Journal Canadien De Chirurgie
    |November 1, 1986
    PubMed
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    Gastrointestinal phytobezoars, particularly in the small bowel, often cause obstruction. Gastric phytobezoars may be managed non-surgically, while small bowel phytobezoars frequently require surgical intervention.

    Area of Science:

    • Gastroenterology
    • Surgical Gastroenterology

    Background:

    • Phytobezoars are indigestible concretions found in the gastrointestinal tract.
    • Previous gastric surgery, such as vagotomy and drainage, is a risk factor for phytobezoar formation.

    Purpose of the Study:

    • To review the clinical presentation, diagnosis, and management of gastrointestinal phytobezoars.
    • To differentiate clinical presentations based on bezoar location (gastric vs. small bowel).

    Main Methods:

    • Retrospective chart review of 16 patients with gastrointestinal phytobezoars from 1975 to 1985.
    • Analysis of patient demographics, surgical history, clinical symptoms, diagnostic methods, and treatment outcomes.

    Main Results:

    • Gastric phytobezoars presented with chronic epigastric pain, nausea, vomiting, anorexia, and weight loss.

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  • Small bowel phytobezoars commonly caused acute small bowel obstruction (crampy abdominal pain, vomiting, obstipation).
  • Endoscopy diagnosed gastric bezoars; X-rays suggested small bowel obstruction. Surgical removal was often necessary for small bowel phytobezoars, while gastric bezoars were managed non-surgically in some cases.

    • Conclusions:

    • Phytobezoar location dictates clinical presentation and management strategy.
    • Small bowel phytobezoars often necessitate surgical intervention due to obstruction.
    • Gastric phytobezoars may be treated conservatively with gastric lavage or dietary modifications.