Small bowel phytobezoars: an uncommon cause of small bowel obstruction

Phytobezoars are an uncommon but important cause of mechanical small bowel obstruction. Seventeen Chinese patients with small bowel obstruction due to phytobezoars underwent 19 operations at the Department of Surgery, The University of Hong Kong at Queen Mary Hospital, accounting for 2% of mechanical small bowel obstruction treated in the past decade. There were ten men and seven women with an average age of 58 years. All except five patients had previous gastric outlet surgery. The diagnosis depends on a high index of suspicion in patients with partial or complete intestinal obstruction. The bezoars were broken down and milked through the ileocaecal valve in seven cases, whereas enterotomy to retrieve the bezoars or resection of small bowel together with the bezoars was performed on ten and two patient, respectively. There was no postoperative mortality but pneumonia and wound infection occurred in four patients. Because of its potential mortality and associated morbidity, patients with previous gastric surgery should be warned about this preventable complication and be given dietary advice. Phytobezoars should be considered in the differential diagnosis of all patients presenting with mechanical small bowel obstruction.