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We herein report a very unusual case of small bowel obstruction caused by phytobezoar in a 69-year-old woman who consumed a large amount of bracken. The patient presented with nausea and vomiting. Computed tomography revealed an air-filled foreign body in the jejunum that had likely caused the small bowel obstruction. A fibrous foreign body diagnosed as a phytobezoar was detected using double-balloon enteroscopy. The obstruction was successfully resolved by crushing the phytobezoar repeatedly using a snare. Small bowel obstructions caused by phytobezoars are often treated with surgical interventions. However, endoscopic fragmentation using a snare is a minimally invasive treatment alternative.

Purpose: To explore the multi-slice spiral computed tomography (MSCT) imaging characteristics of patients with bezoars-induced small bowel obstruction (BI-SBO) to evaluate the risk of conservative treatment., Materials and Methods: This retrospective study included 72 patients with BI-SBO who underwent whole-abdominal MSCT scan within 1 day before treatment. The patients were classified as the non-pass group and pass group depending on whether bezoar can pass after conservative treatment. The CT images were observed and measured by two radiologists. Statistical analysis was performed by using Student's t test, Pearson's chi-squared test, Fisher's exact test, Logistic linear regression, and receiver operating characteristic curve (ROC)., Results: The study population consisted of 72 patients with a mean age of 52.2 ± 16.2 years (32 men and 40 women with an age range of 13-81 years). There were statistical differences between the two groups in the bezoar appearance, maximum HU of bezoar, thickness of intestinal wall, mesenteric haziness, mesenteric fluid, and peritoneal fluid (P = 0.002, 0.024, 0.017, 0.006, 0.021, and 0.030). The appearance of bezoar and mesenteric haziness is independent risk factors affecting whether bezoar can be passed by the conservative treatment. Sensitivity (41.7%) was decreased, NPV (76.3%) was not significantly changed, specificity (93.8%) and PPV (76.9%) were improved when both parameters were met to assess failure of conservative treatment., Conclusion: The observation of important signs by MSCT and its reconstruction technology is of great clinical value in evaluating the passability of bezoar by conservative treatment, and which can provide radiographic basis for clinical treatment selection., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Pharmacobezoars are specific types of bezoars formed when medicines, such as tablets, suspensions, and/or drug delivery systems, aggregate and may cause death by occluding airways with tenacious material or by eluting drugs resulting in toxic or lethal blood concentrations., Objective: This work aims to fully review the state-of-the-art regarding pathophysiology, diagnosis, treatment, and other relevant clinical and forensic features of pharmacobezoars., Results: Patients of a wide range of ages and of both sexes present with signs and symptoms of intoxications or more commonly gastrointestinal obstructions. The exact mechanisms of pharmacobezoar formation are unknown but are likely multifactorial. The diagnosis and treatment depend on the gastrointestinal segment affected and should be personalized to the medication and the underlying factor. A good and complete history, physical examination, image tests, upper endoscopy, and surgery through laparotomy of the lower tract are useful for diagnosis and treatment., Conclusion: Pharmacobezoars are rarely seen in clinical and forensic practice. They are related to controlled or immediate-release formulations, liquid, or non-digestible substances, in normal or altered digestive motility/anatomy tract, and in overdoses or therapeutic doses, and should be suspected in the presence of risk factors or patients taking drugs which may form pharmacobezoars., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

BACKGROUND Indigestible foreign material in the bowel can develop into bezoars. Intestinal obstruction can occur secondary to these bezoars. Phytobezoars specifically refer to those which accumulate as a result of undigested plant or other food material. CASE REPORT A 42-year-old woman presented to the Emergency Department with a several-month history of right-sided abdominal pain associated with bouts of vomiting. She had no other significant medical history. Labs and computed tomography were unrevealing. Gastroenterology was consulted and performed endoscopy. A foreign body resembling an undigested mini bell pepper was found near the terminal ileum. This was removed, and the patient later reported significant improvement in her symptoms. CONCLUSIONS Phytobezoars can lead to symptoms consistent with intestinal obstruction. The underlying pathology (e.g., masses, gastritis, adhesions, or dysmotility) can precipitate obstructions in the setting of bezoar formation. Surgical removal if often necessary for small-bowel obstructions secondary to bezoars, but in our case, fortunately, the foreign body was successfully removed during endoscopy.

To investigate the mechanism of phytobezoar dissolution by Coca-Cola(®), persimmon phytobezoar pieces removed from a 60-year-old Japanese woman were analyzed by energy dispersive X-ray spectroscopy. The amount of calcium significantly decreased after dissolution treatment using Coca-Cola(®), suggesting a potential contribution of calcium to dissolution mechanisms. Moreover, immersion in Coca-Cola(®) for 120 hours on the exterior surface revealed that Coca-Cola(®) did not permeate persimmon phytobezoars. This is the first study to investigate the mechanisms of persimmon phytobezoar permeability and dissolution induced by Coca-Cola(®).

The accumulation of undigested foreign bodies or nutrients in the gastrointestinal tract forming a conglomeration is called a bezoar. Bezoars are referred to according to the foreign bodies that constitute their core: phytobezoar (fibres or seeds of vegetables and fruits); trichobezoar (hair); lactobezoar (remnants of milk) and lithobezoar (rock or similar substances). Although they can be found in any part of the gastrointestinal system, the stomach is the most common site. Primary colonic bezoar is an exceptionally rare situation. Up until 2007, only four colonic lithobezoars had been reported in the literature. This report aims to present the clinical and surgical features of a 4-year-old male patient with a previous history of pica and iron deficiency anaemia, who underwent pebble extraction from the colon after being diagnosed with partial intestinal obstruction.

The role of CT in evaluating patients with small bowel obstruction (SBO) has been extensively described in the current literature. We present the CT findings of SBO due to a phytobezoar, afterwards surgically confirmed, in 5 men and 1 woman (aged 32-89 years) out of 95 patients diagnosed by CT as having SBO in a 44-month period. These six patients underwent abdominal CT prior to operation and the CT findings were retrospectively reviewed. All six patients presented with clinical symptoms and signs of SBO; three of them had undergone gastric surgery 13, 17, and 22 years earlier, respectively. In all six cases, CT showed an ovoid intraluminal mass, 3 x 5 cm in size and of a mottled appearance, at the transition zone between dilated and collapsed small bowel loops. This was in contrast to feces-like material (the "small bowel feces sign"), seen within dilated small bowel loops in nine patients with SBO, and was typically longer. As CT is frequently performed for suspected SBO, an ovoid, short intraluminal mottled mass seen at the site of an obstruction may be regarded as a pathognomonic preoperative sign of an obstructing phytobezoar.

Bezoars are the uncommon result of the ingestion of indigestible or poorly digested substances, which form a solid mass within the gastrointestinal tract. They are classified based on their content and include phytobezoars (plant fibers), trichobezoars (hair), and lactobezoars (milk curds). They may occur in combinations like trichophytobezoars, and can result from virtually anything capable of forming concretions within the gastrointestinal tract, including medications. They are found mainly in the stomach and are rare in the colon. Bezoars are uncommon in children. We report the rare case of a sunflower-seed bezoar impacted at the anal verge in a 6-year-old boy who presented initially with acute gastroenteritis. He required removal of the impaction under sedation.

It is usually impossible to know if reported differences between cultures are due to cultural differences or due to a difference in the methods used to study the cultures. This paper describes a collaborative, multisite study using a shared methodology to study intra- and inter-cultural variation in beliefs. A series of standard interview schedules were used to study Latin American beliefs about empacho in Guatemala, Mexico, and in the United States (Mexican-Americans and Puerto Ricans). Results showed consistency in beliefs about empacho both within and between the four samples.

The clinical signs, changes in blood and rumen fluid, findings at laparotomy, therapy and course of disease of 23 cows with obstruction or compression of the duodenum are described. The duodenum was obstructed by a phytobezoar in 14 cows and by a blood clot in one cow. In eight cows, the duodenum was compressed by and adhered to a liver abscess. The most important clinical findings included moderate to severe disturbance in the general behaviour and attitude, markedly reduced gastrointestinal activity, no or greatly reduced defaecation and abomasal reflux with metabolic alkalosis. Ten cows were slaughtered after clinical examination or exploratory laparotomy. In 13 cows, the phytobezoar was compressed manually to facilitate normal elimination, and if this was not possible, the phytobezoar was removed by enterotomy. Postoperative therapy consisted of intravenous administration of a solution containing sodium chloride and glucose, potassium chloride and intramuscular administration of metoclopramide, procaine penicillin and flunixin meglumine for three to five days. Two of the treated cows were slaughtered a few days postoperatively. There was a rapid improvement in the remaining 11 cows, and general condition, appetite and defaecation returned to normal within a short time.

Two case of the so-called "milk curd obstruction" syndrome are reported. Although seldom found elsewhere than in the stomach, more distal obstruction in the ileum or the transverse colon by milk curd aggregates may mimic more classical causes of obstruction if one is not aware of the possibility of such incident related to feeding. Appropriate interviewing of the mother about regimen and medications will be of great help, in investigating the cause of the abdominal disorder, obviating the need for surgical intervention if confirmed by radiopaque enema.

Gastric bezoar is an uncommon complication of gastric procedures. Increasingly it is managed by pharmacologic or endoscopic manipulations. The risk of intestinal obstruction after nonsurgical therapy is illustrated by two cases that were successfully managed without resorting to enterotomy.