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KMID : 0371319660080050267
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Journal of the Korean Surgical Society
1966 Volume.8 No. 5 p.267 ~ p.277
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Diospyrobezoars
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全烈慶/Chun, Yul Kyung
金敏秀/徐錤植/崔昌祿/Kim, Min Soo/Suh, Ki Sick/Choi, Chang Rock
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Abstract
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In Young Nam Province, there are many persimmons produced in Autumn and most of the people eat both the ordinary and primitive persimmons. The people who eat the unripened persimmons are likely to produce diospyrobezoar.
A substance, shibuol, a phlobatannin compound of phloraglucin and gallic acid is responsible for the pun-gent, astringent taste in the unripened fruit.
The shibuol forms a glue-like coagulum when it comes in contact with a dilute acid such as the hydrochloric acid of the stomach. The coagulum causes the pieces of peel and seeds to form a bolus which often beccrr-es sufficiently large so as to produce intestinal obstruction, intestinal ulcer, or intestinal perforation by its mechanical irritation.
From Dec. 1958 to Nov. 1965, the authors diagnosed 31 cases of diospyrobezoar and reported on their clinical manifestations.
The authors have also reviewed and discussed the classification, pathogenesis, clinical sym?tom:, laboratory studies, diagnosis, complications and treatment of bezoar.
1) During the six months between August to January, diospyrobezoars are most frequently found in clinical experience. Of the total 31 diospyrobezoars which were found, 25 of them occurred during that 6 month period.
2) Of those 31 cases, one patient refused admission and among the 30 cases admitted to the hospital, cre was discharged without operation and two were successfuly treated conservatively. Of those 27 patients who had surgical intervention, twenty six survived operation and did well postoperatively. One patient died cf postoperative air-way obstruction.
3) At surgery twenty-five patients had intestinal obstruction due to diospyrobezoars and two patients had peritonitis due to perforation of the stomach by diospyrobezoers.
4) Of those 27 patients who came to surgery, eighteen cases of diospyrobezoars were found in the ileum. According to the American authors, diospyrobezoars frequently cause gastrointestinal hemorrhage and u´.cer, whereas, in our experience, most of the diospyrobezoars cause intestinal obstruction rather than hemorrhage or ulcer.
5) An abdominal mass was felt in 16 of the total 31 cases and the preoperative diagnosis was correct in 20 of 27 cases that were surgically treated.
Intussusception of bowel and intestinal obstruction, due to ascaris, must be kept in mind as differential diagnoses from intestinal obstruction caused by diospyrobezoar.
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