Roentgenologic Findings in a Case of Phytobezoar

Abstract

THE term “phytobezoar” is applied to a mass found in the stomach or intestines, composed of food materials, such as skins and fibers of fruit, colloid portions of vegetables, and starch granules, with an occasional small amount of other organic material, frequently surrounding fruit seeds. The process by which these food balls are formed is not definitely understood, but it is probable that the gum and pectin contained in the persimmon and other fruit, combined with the muscular activity of the stomach, can be considered as a more or less direct cause. It is generally considered that the formation of the food ball occurs at one particular time, possibly within a few hours after the ingestion of a quantity of fruit, very often die persimmon. However, it is not unreasonable to suppose that more material may be added, and the bezoar be gradually increased in size. The usual clinical picture is that of acute gastritis occurring immediately or within a few hours after the ingestion of the fruit. In the eight cases reported recently by Hart, seven presented acute symptoms of indigestion; in the eighth case the gastric symptoms were chronic, extending over a considerable period of time. After medical treatment in which hydrochloric acid was administered, small masses were passed in the feces, which contained apparently prunes, bits of raisin skins and stems, and vegetable detritus. Following the treatment, the tumor that had been previously noticed in the epigastrium disappeared, and the symptoms subsided. The case which we wish to report gave a similar chronic history. Mr. W., age 42, occupation, farmer. The patient applied for examination and treatment of some gastric disturbance. The present trouble began four or five years ago. No idea was offered as to the cause. The distress began as a heavy sensation in the region of the stomach, sometimes in the throat, coming on three or four hours after meals. This was not a constant affair, but occurred about once a week. Since then it has gradually increased in frequency and in severity so that, for the past few months, the patient has had a gnawing, burning pain in the region of the stomach three or four hours after meals, attended by more or less belching of gas, and sour stomach. This distress was always relieved by the intake of food. Sodium-bicarbonate had not been tried. The patient never vomited any blood or passed any black, tarry stools so far as he knows. Always a fairly hearty and rapid eater, and fond of highly seasoned foods. The patient has, nevertheless, been regular about his meals. The barium-meal study revealed a decided thinning out of the barium in about the middle portion of the stomach. This area measured two and a half to three inches in diameter, and it was found on manipulation that this apparent mass could easily be made to change its position; it being possible to move it to any desired point in the stomach from cardia to pylorus.