Intestinal Obstruction due to Bezoar in Elderly Patients: Risk Factors and Treatment Results.

Fatih Altintoprak,Eyup Gemici,Yasin Alper Yildiz,Mustafa Yener Uzunoglu,Taner Kivilcim

doi:10.1155/2019/3647356

Abstract

Purpose Bezoars are foreign particles from the accumulation of indigestible materials in the gastrointestinal system and a rare cause of mechanical intestinal obstruction. We aimed at investigating differences in risk factors for the development of intestinal obstruction associated with bezoar in elderly patients. Methods Hospital records of patients who underwent surgery associated with phytobezoar between January 2004 and May 2016 were retrospectively evaluated. Patients were divided into two groups [<65 years (Group 1) and ≥65 years (Group 2)]. Data were examined regarding presence of comorbidity, history of abdominal surgery, operation time, bezoar site, surgical technique, length of hospitalization, morbidity, and mortality. Results Of 121 patients enrolled, 48 (39.7%) were male and 73 (60.3%) were female (range: 24-86 years). Group 1 consisted of 69 patients aged < 65, while Group 2 consisted of 52 patients aged ≥ 65. Comorbidity was reported in 52 (42.9%) patients (mostly diabetes mellitus, 20.7%), while 60 patients (49.6%) had history of abdominal surgery (mostly peptic ulcer, 27.3%). No statistical differences were found between the two groups in terms of sex, bezoar site, surgical technique preferred, history of abdominal surgical intervention, pre- and postoperative CT examination, morbidity rates, and length of hospitalization. But, ratio of peptic ulcer operations history, presence of total comorbidity, and time of surgery decision was higher in Group 2 patients. Conclusion In bezoar-related intestinal obstruction, duration and outcome of treatment are not affected by age distribution. Possibility of bezoar should primarily be considered in elderly patients with history of peptic ulcer operation.

Highlights

Acute mechanical intestinal obstruction (AMIO) is a condition in which the contents of the intestinal lumen are prevented from advancing due to various causes and that generally requires emergency surgical intervention
It is emphasized that the presence of bezoar possibility in elderly patients may be more than expected if there are some factors, such as diabetes mellitus and previous peptic ulcer surgery history
AMIO cases associated with phytobezoars are commonly encountered in our region, which is a natural habitat for the growth of persimmon

Summary

Introduction

Acute mechanical intestinal obstruction (AMIO) is a condition in which the contents of the intestinal lumen are prevented from advancing due to various causes and that generally requires emergency surgical intervention. The etiology of intestinal obstruction is varied, this condition, which constitutes approximately 20% of all emergency surgical interventions, is mostly caused by adhesions associated with previous abdominal surgical interventions [1]. Bezoar is a term used to describe indigestible materials that are orally ingested and that accumulate in the gastrointestinal system as intraluminal foreign particles They have various names according to the material they are composed of, including phytobezoars, trichobezoars, and lactobezoars. Studies have demonstrated that phytobezoars are generally one of the least common and rare causes of intestinal obstruction [4]. They are the most commonly reported etiological factor of intestinal obstruction in certain geographical areas where very high fiber-containing food (e.g., persimmons) are grown and consumed [5]. Apart from fiber-rich food consumption, many risk factors have been described

Methods

Results

Conclusion