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KMID : 0371319720140030001
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Journal of the Korean Surgical Society
1972 Volume.14 No. 3 p.1 ~ p.8
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Intestinal Obstruction due to Bezoars
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李性鍾/Lee, Sung Jong
申正淳/申洪均/孫基燮/Shin, Jung Soon/Shin, Hong Kyun/Son, Ki Sub
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Abstract
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It has reported Bezoars are infrequently encountered in the study of disease of the gastrointestinal
tract but we had experienced rather high incidence in our clinic, department of general surgery, in
Chung-nam Medical Center during from March 1967 to November 1971.
The purpose of this report os tp review of literature to describe about factors responsible and pathog
enesis for this diseases with to analyze eleven clinical cases that had experienced in our department.
Bezoars have a history dating back to 923 AD where they were listed in a pharmcopoeia as either an
arabic "parzohr", or persian "padzohr", antidote or counterpoison.
Bezoars may be classified into 4 categories, trichobezoars, which is consist of matted hair, phytobezoars
consis of various vegetable structures and fruit products such as leaves, skins, seeds, fibers, roots and
others. Trichophytobezoars, combinations of these two and concretions, which is rare forms of bezoars
consist of precipitated or solidified chemical that have been ingested on purpose or accidentally 6).
De Bakey and Ochsner reported that of 311 cases, 55% were trichobezoars which were most common
type, 40% were phytobezoars and the rests were concretions. And more than 70∼85% of all phytozoars
are caused by ingestion of unripened green permissions which because of a special designation, diospy
robezoar have been given for that (Lipin and Hara, 1962. Jagge and Sasser, 1967).
The japanese worker Izumi, Isida and Iwamoto 23) pointed out that the unripened green persimmins
contain large amount of soluble tannins, The soluble tannins that are ingested, are converted by the
action of the hydrochloric acid in the gastric juice, especially in the empty stomach, into the anhydric
sticky mass that agglutinates fragments of persimmon pulp and seed. About 70% of phytobezoars occur
in patient over 30 years of age and 77% of affected patients are males.
Chief clinical signs and symptoms are nausea, vomiting, cramping abdominal pain and a palpable abd
ominal mass.
De Bakey and Ochsner reported the over all mortality rate in cases that were treated conservatively
or medically approached 66%, while approximately 7% of the operated cases died. Therefore prompt
surgical intervention is always mandatory if diagnosis has been confirmed.
Between from March 1967 to November 1970, authors had experienced patients that were suffered
from intestinal obstruction due to bezoar after had eaten persimmons.
The chief signs and symptoms were nauseam vomiting, abdominal pain, a palpable mass in the abdo
men and leucocytosis. All clinical manifestations but one, leucocytosis, are almost same as other reporters.
And the remarkbale fact was that every cases had developed intestinal obstruction.
Age of all patients except two, 20 year and 28 year old respectively, were between 16 year old and
6 year old. 9 patients were males.
All patients were delivered from a certain district throughout neighbouring district of Daduk, Okchun,
Yungdong and Kumsan in the provinces of Chungnam and Chungbuk.
All of 11 cases were operated iupon for intestinal obstruction due to bezoar with adequate supplemen
tary treatment such as decompression of distended intestine and application of fluid, electrolyte and
antibiotics. Authors rempved all bezoars through gastroduodenotomy (1 case), jejunotomy (3 cases) and
ileotomy (7 cases).
The postoperative causes of all cases were uneventful, and the patients, feeding well, were discharged.
Authors emphasize that it is also surgeon´s duty to instruct the patient to masticate fruit and veget
able throughly and avoid swallowing intact fruit segments especially for the patients with artificial teeth,
peptic ulcer and with previous vagotomy and gastroenterostomy or pyloroplasty.
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