Persimmon Phytobezoar Research Articles

BEZOARS: CLINICAL CHARACTERISTICS, CLASSIFICATION AND MANAGEMENT, A REVIEW ARTICLE

Introduction- The formation of a bezoar is a relatively rare disease entity. Bezoars are mainly of four types depending on their composition: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. Depending on their location in gastrointestinal tract they are classied intoGastric bezoars which often lead to ulcerative lesions in the stomach and subsequent bleeding, and theSmall intestinal bezoars which usually present with small bowel obstruction. Xray abdomen and USG abdomen are less s Diagnosis – ensitive to diagnose bezoars while GI endoscopy and CT scan abdomen better modalities to make a diagnosis of bezoars. A number of a Management- rticles have emphasized the usefulness of CocaCola administration for the dissolution of phytobezoars. However, persimmon phytobezoars are resistant to such dissolution because of their harder consistency.Cellulase and Papain are used to dissolve bezoars. Endoscopic removal, electro-hydrolytic lithotripsy, argon plasma coagulation are a few newer techniques used. Surgical removal of bezoars, both open and laparoscopically are performed if dissolution methods and endoscopic methods fail. Here we provide an overview of the prevalence, classication, predisposing factors, clinical features,diagnosis and management with review and recent updates

Bowel Obstruction Caused by Persimmon Phytobezoars: A Case Report

Background: The term phytobezoar refers to a trapped mass in the gastrointestinal tract caused by the agglomeration of indigestible ingested plant materials, including fibers, skins, and seeds. A persimmon phytobezoar is formed after the frequent consumption of persimmons. The clinical manifestations of persimmon phytobezoars are similar to other phytobezoars and depend on the localization and size of the trapped mass. Case Presentation: Here, we presented a 57-year-old male with persimmon phytobezoars, which finally led to small bowel obstruction. The patient was referred to the emergency room with complaints of severe abdominal pain and frequent vomiting. The patient underwent laparotomy surgery that led to the removal of a portion of his ileum. Conclusion: Overindulgence in taking persimmon can lead to formation of phytobezoar and subsequent obstruction of small intestinal. Persimmon phytobezoars are difficult to break up into pieces because of containing tannins, cellulose, hemicellulose, and lignin.

Gastric outlet and ileal obstruction due to recurrent persimmon phytobezoar: clinical image

Gastric outlet and ileal obstruction due to recurrent persimmon phytobezoar: clinical image

An unusual case of gastric outlet obstruction caused by multiple giant persimmon phytobezoars.

A phytobezoar is a bezoar or trapped mass in the gastrointestinal system that consists of indigestible plant material such as fibers, skins and seeds. A persimmon phytobezoar (considered to be harder than other types of phytobezoars) is formed after frequent consumption of persimmons. The complication of gastrointestinal tract obstruction from bezoars was found to exist in the intestines but was rarely reported in the gastric tract because of its flexible volume. Here we present a 57-year-old man with persimmon phytobezoars, which ultimately led to gastric outlet obstruction.

Review of the diagnosis and management of gastrointestinal bezoars.

The formation of a bezoar is a relatively infrequent disorder that affects the gastrointestinal system. Bezoars are mainly classified into four types depending on the material constituting the indigestible mass of the bezoar: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. Gastric bezoars often cause ulcerative lesions in the stomach and subsequent bleeding, whereas small intestinal bezoars present with small bowel obstruction and ileus. A number of articles have emphasized the usefulness of Coca-Cola(®) administration for the dissolution of phytobezoars. However, persimmon phytobezoars may be resistant to such dissolution treatment because of their harder consistency compared to other types of phytobezoars. Better understanding of the etiology and epidemiology of each type of bezoar will facilitate prompt diagnosis and management. Here we provide an overview of the prevalence, classification, predisposing factors, and manifestations of bezoars. Diagnosis and management strategies are also discussed, reviewing mainly our own case series. Recent progress in basic research regarding persimmon phytobezoars is also briefly reviewed.

柿胃石の成分分析における標準物質としての柿渋の有用性

柿胃石の成分分析における標準物質としての柿渋の有用性

PERSIMMON PHYTOBEZOARS IN MEERKATS (SURICATA SURICATTA)

Two meerkats (Suricata suricatta) died acutely and gastric bezoars were found at necropsy. Four of the eight remaining meerkats had bezoars identified radiographically. Surgical gastrotomies were performed and bezoars containing orange fibrous material were removed. Histologic examination of the bezoars and persimmon fruit from a tree in the exhibit revealed that the materials were identical. Tannins found in ripe persimmons are known to coagulate in the presence of gastric acid, and the resultant phytobezoars can lead to gastrointestinal obstructions. All four meerkats recovered uneventfully. The combination of interspecies aggression and a diet change may have led to consumption of persimmons produced by a tree in the exhibit. Persimmon phytobezoars are also seen in humans and horses.

Gastric and enteric phytobezoars caused by ingestion of persimmon in equids

CASE DESCRIPTION-13 equids (10 horses, 2 donkeys, and 1 pony) were examined for signs of colic (n = 7), weight loss (6), anorexia (3), and diarrhea (2). Ten equids were evaluated in the fall (September to November). Seven equids had a history of persimmon ingestion. CLINICAL FINDINGS-A diagnosis of phytobezoar caused by persimmon ingestion was made for all equids. Eight equids had gastric persimmon phytobezoars; 5 had enteric persimmon phytobezoars. Gastroscopy or gastroduodenoscopy revealed evidence of persimmon ingestion in 8 of 10 equids in which these procedures were performed. TREATMENT AND OUTCOME-2 of 13 equids were euthanatized prior to treatment. Supportive care was instituted in 11 of 13 equids, including IV administration of fluids (n = 8) and treatment with antimicrobials (5), NSAIDs (5), and gastric acid suppressants (4). Persimmon phytobezoar-specific treatments included dietary modification to a pelleted feed (n = 8); oral or nasogastric administration of cola or diet cola (4), cellulase (2), or mineral oil (2); surgery (4); and intrapersimmon phytobezoar injections with acetylcysteine (1). Medical treatment in 5 of 7 equids resulted in resolution of gastric persimmon phytobezoars. Seven of 8 equids with gastric persimmon phytobezoars and 1 of 5 equids with enteric persimmon phytobezoars survived > 1 year after hospital discharge. CLINICAL RELEVANCE-Historical knowledge of persimmon ingestion in equids with gastrointestinal disease warrants gastroduodenoscopy for evaluation of the presence of persimmon phytobezoars. In equids with gastric persimmon phytobezoars, medical management (including administration of cola or diet cola and dietary modification to a pelleted feed) may allow for persimmon phytobezoar dissolution.

Persimmon Phytobezoar as the Cause of Small Bowel Obstruction

The most common cause of small bowel obstruction is intra-abdominal adhesions resulting from previous abdominal surgery, and persimmon phytobezoar as the cause of small bowel obstruction is rare. We report a 47-year-old male patient with a history of previous gastric surgery, who visited our emergency room because of increasing abdominal pain, distension and episodic vomiting for one day. Small bowel obstruction secondary to intra-abdominal adhesion was initially suspected but was later diagnosed by abdominal CT as an obstructing phytobezoar in the ileum. This diagnosis was confirmed by exploratory laparotomy. Early identification and surgical intervention are considered necessary to prevent ischemia and perforation of the small bowel.

Acute Intestinal Obstruction Caused by a Persimmon Phytobezoar after Dissolution Therapy with Coca-Cola

Bezoars are concretions or hard masses of foreign matter that are found in the gastrointestinal tract. Recent reports have demonstrated the efficacy of Coca-Cola administration for the dissolution of phytobezors. Here we report on a 73-year-old man with a very large gastric persimmon diospyrobezoar, and this caused small intestinal obstruction after partial dissolution with oral and injected Coca-Cola.

Persimmon bezoars: A successful combined therapy

Background: Persimmon phytobezoar, although an infrequent entity, is not rare in some countries. Because of their particular features, management of diospyrobezoars is difficult. A number of surgical, endoscopic, and pharmacologic treatments have been proposed with variable success. This is a description of our experience with 10 patients with a new combination therapy. Methods: Ten patients (7 men, 3 women; mean age 46.4 years) were treated with a new fragmentation technique consisting of a saw-like effect with a large polypectomy snare followed by administration of cellulase, cysteine, and metoclopramide. Results: Resolution was achieved in 8 patients. Complications (intestinal obstruction) developed in 2 patients. Conclusions: Our combined therapy is safe and highly efficacious but caution must be exercised because intestinal obstruction can occur if large fragments pass through the pylorus. A more extensive study is required to assess these clinical observations.

Pathogenetic aspects of persimmon bezoars. A case-control retrospective study.

To prove that ingestion of unpeeled persimmon is necessary for the development of a persimmon phytobezoar, we interviewed 15 patients, in most of whom this condition developed after peptic ulcer surgery. We compared the study group with a control group of 15 patients who had undergone peptic ulcer surgery but did not have a bezoar. In contrast with the control group, most patients with bezoars had ingested unpeeled fruits (p < 0.01). While ingestion of persimmon carried a 9.8-fold risk of bezoar development, ingestion of the unpeeled fruit increased the risk of this complication 56 times over that of age- and sex-matched controls. We recommend that patients who have undergone ulcer surgery be warned particularly against eating unpeeled persimmons.

Gastric phytobezoar presenting as gastric outlet obstruction in a child after Sugiura operation for bleeding esophageal varices

A case of gastric outlet obstruction caused by persimmon phytobezoars in a 14-year-old boy who had undergone a Sugiura operation for bleeding esophageal varices 5 years before admission is reported. Although most gastric bezoars represent a complication of previous gastric surgery, the occurrence in childhood after a Sugiura operation has not been previously reported.

Surgical aspects of gastrointestinal persimmon phytobezoar treatment

One hundred thirteen patients presented with gastrointestinal complications due to persimmon phytobezoars during a 3 year period. One hundred three patients had a history of persimmon ingestion. One hundred five patients had undergone previous gastric operation for duodenal ulcer, one patient underwent highly selective vagotomy, and seven patients had not undergone previous operation. An elevated temperature, leukocytosis, and decreased bowel sounds were typical early clinical manifestations of small bowel obstruction by persimmon phytobezoars. In 13 patients, gastric bezoars were found, in 20 patients, gastric and intestinal bezoars, and in 80 patients, intestinal bezoars. One hundred patients were treated surgically. In 14 of the 20 patients with concomitant gastric and intestinal phytobezoars, extraction of the bezoars was achieved by gastrotomy. Of the remaining six patients, it was achieved by intraoperative milking of the gastric bezoar into the small bowel in two patients and by conservative treatment in four patients. Of the 100 patients who presented with small bowel obstruction, 60 were treated by milking of the bezoar into the large bowel, 34 by enterotomy, and 6 by conservative therapy with intravenous fluids, gastric suction, and a water-soluble contrast meal. Small bowel resection of a gangrenous segment was necessary in two patients. Two patients died after operation because of sepsis and respiratory complications. Eleven of the 13 patients in whom postoperative wound infection developed underwent gastrotomy or enterotomy. We conclude that the treatment of choice of intestinal obstruction due to persimmon phytobezoars is milking of the bezoar into the large bowel without enterotomy. Preoperative or operative endoscopy should be performed in patients presenting with complications of gastrointestinal phytobezoars. Patients who have undergone gastric operation should be warned against the risk of persimmon ingestion.

Nonpersimmon Gastric Phytobezoars

To the Editor. —I read with great interest the article of Zarling and Thompson on nonpersimmon gastric phytobezoar in theArchives.1The fact that nonpersimmon gastric phytobezoars have been shown to differ clinically, and in their evolution, from the persimmon bezoars is an interesting finding and may reflect partially a different pathophysiology. Indeed, the formation of the persimmon phytobezoars necessitates gastric secretions for the agglutination of phlobatannin, whereas no such involvement has been described in the nonpersimmon bezoars. It remains, however, that regardless of clinical differences and severity of complications, gastroparesis, whether surgically induced, metabolically related, or idiopathic, represents a key element in the accrual and progression if not in the recurrence of the bezoar and should be addressed in that perspective. In our article Metoclopramide in the Treatment of Gastric Bezoars,2we have shown that properly documented by radioisotope gastric emptying test and endoscopy, gastroparesis and its

Nonpersimmon Gastric Phytobezoar

Phytobezoars are intragastric concretions composed of food or persimmon fruit. Previous studies of patients with phytobezoars have had a preponderance of patients with persimmon phytobezoars; little clinical information is available regarding nonpersimmon phytobezoars. We report the cases of 52 patients with nonpersimmon phytobezoars and contrast our experience with that previously reported for patients with persimmon phytobezoars. Our patients experienced pain (67%), nausea and vomiting (50%), diarrhea (13%), and gastric ulcers (14%). No patient with a phytobezoar died. Two thirds of our patients had conditions that could alter gastric motility. Medical therapy successfully dissolved 91% of the phytobezoars. One fifth of our patients had a phytobezoar redevelop. Compared with patients with persimmon phytobezoars, we conclude that patients with nonpersimmon phytobezoars have (1) different symptoms, (2) a low risk of complications or death, (3) effective medical therapeutic options, and (4) a 19% risk of phytobezoar recurrence.

Persimmon Phytobezoar Mistaken for Gastric Cancer

Persimmon phytobezoar is not a rare finding in the Southern States. An excellent paper on this subject was presented by Dr. Richard White,2 in which he reviewed the literature and presented three of his own cases. The association of a gastric ulcer in the presence of a phytobezoar is unusual, as is the association of a phytobezoar in a carcinomatous stomach. When the phytobezoar produces such changes in the stomach that it simulates roentgenologically advanced cancer of the stomach and is diagnosed as such, the case is worth adding to the literature on phytobezoars. Case Report.—This 38-year-old trusty prisoner entered the McAlester Oklahoma State Penitentiary Hospital in July, 1939, with a history of profuse hemoptysis and sharp gastric pain of ten days' duration. He gave a history of irregular gastric distress for several months prior to the onset of gastric bleeding. The rest of his history obtained on admission was negative. On admission to the hospital, the patient was extremely weak, showed evidence...