Phytobeozar large bowel obstruction – The prickly pear (A single centre experience and case series report)

Abstract

IntroductionA bezoar, describes a non-digestible item material. Phytobezoars described in the literature include celery, pumpkins and grape skins. There is a lack of literature describing the Opuntia ficus-indica, also known as the prickly pear, as a cause of phytobezoar obstruction. AimTo describe a single centre experience with prickly pear bowel obstruction and to perform a case series about prickly pear obstruction. Results23 patients required surgical manual disimpaction under anaesthesia due to large bowel obstruction caused by prickly pears between 2014 and 2017. No correlation was identified between quantity ingested and risk of obstruction. A ′faecoloma' was visible on plain abdominal radiographs in most patients. Administration of laxatives was administered in most patients after the manual disimpaction. ConclusionIn conclusion, the opuntia ficus indica is a 'multi-purpose' fruit used from the agricultural sector to the pharmaceutical industry. Its use is likely to increase worldwide, including as a source of food/delicacy, espiceially in countries who promote it as part of their traditional gastronomy. Our experience, has taught us, the prickly pear seeds can lead to large bowel faecal impaction secondary to distal faecoloma formation, when consumed, with no obvious correlation between quantity ingested and risk of obstruction. Utilisation of the osmotic based laxatives is effective but manual disimpaction may be necessary for the phytobezoar induced large bowel obstruction to be relieved.