Bowel Obstraction due to Bezoar, Report of 19 cases

Introduction: Bezoar are undigested substances that have remained in the gastrointestinal tract for various reasons. One of the rare complications of bezoar which has been studied in this cases series is gastrointestinal obstruction. Methods: This study performed in Imam Huossein Hospital in Tehran. In this study all patients with diagnosis of small bowel obstruction who underwent surgery with bezoar as final pathology were enrolled, over a period of 2 years from 2015 to 2017. Demographic and laboratory data and intraoperative findings were evaluated and analyzed in these patients. Results: There was 19 patients that 12 of them were female and 7 were male. The mean age of the patients was 63.84 years.15 patients were referred in winter and autumn and 4 patients in spring and summer. Associated diseases include diabetes (42%), history of abdominal surgery (15 %), and hypothyroidism (5%). Extracted materials include persimmon (47%), unknown substances (38%), pomegranate (10%), hair (5%).The most common clinical symptoms include abdominal pain (87%), nausea and vomiting (80%), inability to gas passage or defecation. In physical examination findings were abdominal distention (85 %), decreased bowel sounds (52%), abdominal tenderness (48%), empty rectum in DRE (45%).Laboratory findings include leukocytosis (78%), metabolic acidosis (42 %), pre-renal azotemia (32 %). The most common sites of obstruction were last 100 cm of ileum (13 patients), jejunum (4 patients), both gastric and small intestine concurrent (2 patient).Of these patients, 68% (13 patients) underwent enterotomy to remove bezoar and milking applied to 6 patients (32%). Conclusion: Bezoar is one of the relatively rare causes of small bowel obstruction. In elderly patients with underlying factors for Bezoar, as well as recent history of fruit consumption with potential to form Bezoar in autumn and winter can be helpful in detecting obstruction caused by Bezoar.