Abstract
Objective To investigate the curative effect of a transnasal ileus tube in the treatment of small bowel obstruction caused by a phytobezoar. Methods Seventy-one patients with small bowel obstruction caused by a phytobezoar who underwent treatment in three provincial tertiary grade A hospitals in Fujian Province from March 2011 to February 2020 were included in this study. Patients were divided into the following two groups according to the treatment received: (1) conservative group, comprising patients who received medical conservative treatment, and (2) combined group, including patients who received combined medical conservative treatment and transnasal ileus tube placement. The clinical symptoms, changes in abdominal imaging, tube depth of the first day, reduction of pressure volume on the first day after catheterization, length of hospital stay, and nonsurgical rate were compared between the combined and conservative groups. Results There was no significant difference in age, sex, history of previous abdominal surgery and abdominal radiotherapy, symptoms at admission, duration of symptoms before admission, signs at admission, laboratory data, and obstruction position between the combined and conservative groups. There was a statistically significant difference in the nonsurgical rate (19/24 vs. 23/47, P = 0.014) between the combined and conservative groups. Logistic analysis showed that the duration of symptoms before admission, albumin level, and use of a transnasal ileus tube might be independent factors affecting the transition to surgery for patients with small bowel obstruction caused by a phytobezoar (P < 0.05). Conclusion Timely conservative medical treatment with transnasal ileus tube placement can effectively improve the nonsurgical rate of small bowel obstruction caused by a phytobezoar. The duration of symptoms before admission, albumin level, and use of a transnasal ileus tube were closely related to whether patients with small bowel obstruction caused by phytobezoar were transferred to surgery.
Highlights
The formation of a phytobezoar is often related to the large amount of tannic acid and pectin in the food, which are found in higher concentrations in fruits and vegetables such as persimmons, jujube, and hawthorn
This study was aimed at analyzing the treatment and prognosis of patients with small bowel obstruction caused by a phytobezoar, at exploring the curative effect of the transnasal ileus tube in treating these cases, and at identifying risk factors affecting the transition to surgery in this patient cohort
Seventy-one patients were divided into the following two groups according to the different treatment methods: (1) conservative group, comprising patients who received medical conservative treatment for small bowel obstruction caused by a phytobezoar, and (2) combined group, including patients who received the abovementioned conservative treatment combined with transnasal ileus tube application (Figure 2)
Summary
The formation of a phytobezoar is often related to the large amount of tannic acid and pectin in the food, which are found in higher concentrations in fruits and vegetables such as persimmons, jujube, and hawthorn. Tannic acid and pectin in food can form a water-insoluble gel-like substance after interacting with gastric acid or other proteins in the gastrointestinal tract, which are called phytobezoars [1]. There are few related studies on the curative effect of the transnasal ileus tube on the treatment of small intestinal obstruction caused by phytobezoars. This study was aimed at analyzing the treatment and prognosis of patients with small bowel obstruction caused by a phytobezoar, at exploring the curative effect of the transnasal ileus tube in treating these cases, and at identifying risk factors affecting the transition to surgery in this patient cohort
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