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Hong IT, Cha JM, Ki HJ, Kwak MS, Yoon JY, Shin HP, Jeoun JW, Choi SI. Small Bowel Obstruction Caused by Aloe vera Bezoars: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 69:312-315. [PMID: 28539037 DOI: 10.4166/kjg.2017.69.5.312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Small bowel obstruction is a clinical condition commonly caused by postoperative adhesion, volvulus, intussusceptions, and hernia. Small bowel obstruction due to bezoars is clinically uncommon, accounting for approximately 2-4% of all obstructions. Computed tomography (CT) is a useful method in diagnosing the cause of small bowel obstruction. However, small bowel obstruction caused by bezoars may not be detected by an abdominal CT examination. Herein, we report a rare case of small bowel obstruction by Aloe vera bezoars, which were undetected by an abdominal CT. Phytobezoars should be included in the differential diagnosis of small bowel obstruction in patients with predisposing factors, such as excessive consumption of high-fiber food and diabetes.
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Affiliation(s)
- In Taik Hong
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hye Jin Ki
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Won Jeoun
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
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Occhionorelli S, Zese M, Targa S, Cappellari L, Stano R, Vasquez G. A rare case of a double phytobezoar causing gastric and jejunum obstruction in an adult man: a case report. J Med Case Rep 2016; 10:350. [PMID: 27978851 PMCID: PMC5159969 DOI: 10.1186/s13256-016-1137-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023] Open
Abstract
Background Bezoars are an uncommon cause of mechanical intestinal occlusion. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Symptoms are classically indistinguishable from one another and from more common causes of intestinal occlusion, so it can be difficult to establish a correct diagnosis in order to apply the correct treatment. We present a rare case of two different phytobezoars causing intestinal occlusion (gastric and jejunal). We also describe the correct techniques for making a correct and fast diagnosis of occlusion caused by phytobezoars, and the possible conservative and operative treatments. Case presentation We present the case of a double phytobezoar that was surgically treated with a double enterotomy. Our patient was a 68-year-old Caucasian man with a medical history of hypertension, a previous open appendectomy, and open repair of a perforated gastric ulcer. He was admitted with a 5-day history of abdominal pain located in his upper quadrants along with vomiting. After a preoperative examination, he was taken to the operating room. He was discharged in a good clinical condition 11 days after surgical intervention. A physical examination at 6 months demonstrated our patient was in good health. Conclusions Diagnosing bezoars is difficult because of their rarity. However, they must be taken into consideration in a differential diagnosis because their treatment is not always surgical. In fact, it may be conservative in many cases and a correct diagnosis will guide towards the correct therapy.
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Affiliation(s)
- S Occhionorelli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and Sant' Anna Universitary Hospital of Ferrara, Ferrara, Italy
| | - M Zese
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and Sant' Anna Universitary Hospital of Ferrara, Ferrara, Italy.
| | - S Targa
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and Sant' Anna Universitary Hospital of Ferrara, Ferrara, Italy
| | - L Cappellari
- Department of Surgery, Emergency Surgery Service, Sant'Anna University Hospital, Ferrara, Italy
| | - R Stano
- Department of Surgery, Emergency Surgery Service, Sant'Anna University Hospital, Ferrara, Italy
| | - G Vasquez
- Department of Surgery, Emergency Surgery Service, Sant'Anna University Hospital, Ferrara, Italy
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Hussein BA, Khammas A, Al-Ozaibi L, Abdallah A, Busharar H, Al-Mazrouei A, Badri F. Phytobezoar impaction in a Meckel's diverticulum; a rare cause of bowel obstruction: Case report and review of literature. Int J Surg Case Rep 2016; 30:165-168. [PMID: 28012337 PMCID: PMC5198632 DOI: 10.1016/j.ijscr.2016.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/30/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum is the most common anomaly of the gastrointestinal tract, occurring in 1-3% of the general population. The most common complication of Meckel's diverticulum is intestinal obstruction. In this report, we describe a rare cause of intestinal obstruction due to Meckel's; the phytobezoar. After thorough literature review, the authors found about ten individual reports of the same topic. In all these cases, diagnosis was established intra-operatively. CASE PRESENTATION A forty-seven-year old male presented to the emergency department with a one-day history of abdominal pain associated with vomiting and constipation. Physical examination diagnostic tests revealed features of intestinal obstruction. DISCUSSION The lifetime risk of complications in patients with a Meckel'sdiverticulum is usually small and occurs only in up to 4%. In adults' intestinal obstruction is the most common complication (40%). CONCLUSION Complicated Meckel's diverticulum can have different clinical presentations and can cause bowel obstruction. An association with bezoars impaction is possible and it should be suspected in adult patients presenting with bowel obstruction of unknown causes especially those with high vegetarian diet.
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Affiliation(s)
- Bassem Abou Hussein
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Ali Khammas
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Labib Al-Ozaibi
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Alyaa Abdallah
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Hajer Busharar
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Alya Al-Mazrouei
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Faisal Badri
- General Surgery Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Ileal stricture following Meckel's diverticulitis: a rare cause of intestinal obstruction. Clin J Gastroenterol 2016; 9:118-23. [PMID: 27146826 DOI: 10.1007/s12328-016-0647-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/23/2016] [Indexed: 12/21/2022]
Abstract
We report a very rare case of Meckel's diverticulitis with ileal stricture at the base of the diverticulum in a young adult as a cause of recurrent small bowel obstruction lasting for 7 years. None of the pre-operative investigations were able to diagnose the cause of obstruction. The patient had undergone appendicectomy 3 years ago but without any relief. Thereafter he was given a therapeutic trial of anti-tubercular drugs, but his symptoms rather worsened with this treatment. Finally, the diagnosis of Meckel's diverticulitis with ileal stricture was made on exploratory laparotomy. The patient recovered well following segmental ileal resection including the stricture and inflamed Meckel's diverticulum. This unusual case highlights that such a rare clinical entity should be considered as a differential diagnosis while dealing with cases of recurrent distal ileal obstruction so as to avoid misdiagnosis and mismanagement as happened in the present case.
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Maia DS, Ferreira-Júnior M, Viegas RG, Silva EEC, Oliveira PDTVD, Silva RCAD, Caetano AJ, Ferreira NG. Bowel obstruction in Meckel diverticulum. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:244-5. [PMID: 24190387 DOI: 10.1590/s0102-67202013000300018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ertuğrul G, Coşkun M, Sevinç M, Yelimlieş B, Ertuğrul F, Toydemir T. A rare cause of gastrointestinal phytobezoars: diospyros lotus. World J Emerg Surg 2012; 7:19. [PMID: 22721161 PMCID: PMC3438099 DOI: 10.1186/1749-7922-7-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/21/2012] [Indexed: 12/03/2022] Open
Abstract
Aim Diospyros Lotus (“Wild Date Palm of Trabzon or Persimmon”), which has been proven to cause phytobezoars, is a widely consumed fruit in the Black Sea and Northeast Anatolia regions of Turkey. The aim of the present study was to investigate the effects of Diospyros Lotus together with other predisposing factors, on the development of gastrointestinal phytobezoars and to discuss the treatment results in comparison to the literature. Material and method The records of 13 patients, who had been admitted to the General Surgery Clinic of Düzce Atatürk State Hospital between August 2008 and August 2011, were retrospectively reviewed. Demographic characteristics, predisposing factors, clinical and radiological findings, diagnostic and therapeutic methods, and the outcomes of the patients were recorded from the patient files. Written informed consent was obtained from each patient for publication of this research article and accompanying images. Results All the patients had a history of consuming Diospyros Lotus. Of the patients, 30,7% had a history of previous gastric surgery, 30,7% had diabetes mellitus and 23% had dental implants. None of the patients had hypothyroidism, which is another predisposing factor for phytobezoars. The phytobezoars were located in the stomach alone in 23% of the patients, whereas 15,3% was detected in the jejunum and stomach, 15,3% was detected in the jejunum alone, and 46,1% was detected in the ileum alone. All patients were treated with surgery, and there were no deaths. Conclusion Gastric phytobezoars are rare. Preventive measures have particular importance in the management of this condition, which is difficult to treat. For this purpose, excessive consumption of herbal nutrients containing a high amount of indigestible fibers such as Diospyros Lotus should be avoided in patients with a history of gastrointestinal surgery or poor oral and dental health.
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Affiliation(s)
- Gökhan Ertuğrul
- Department of General Surgery, Düzce Atatürk State Hospital, Muncurlu, Düzce, Turkey.
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Abstract
BACKGROUND AND OBJECTIVES Meckel's diverticulum is a common anomaly of the gastrointestinal tract that may result in gastrointestinal bleeding, diverticulitis, and small bowel obstruction. This report describes the use of laparoscopy to treat a rare complication of Meckel's diverticulum-small bowel obstruction due to phytobezoar impaction. More generally, it provides an example of the feasibility and utility of a laparoscopic approach to small bowel obstructions of unknown causes. METHODS A 34-year-old male presented to the emergency department complaining of episodic abdominal pain and vomiting. He had no history of abdominal surgery. His vital signs were stable, and his abdomen was distended, but only mildly tender. He had no abdominal wall hernias on examination. Imaging was consistent with small bowel obstruction. He was brought to the operating room where laparoscopy revealed a Meckel's diverticulum with an impacted phytobezoar as the source of obstruction. The diverticulum was resected and the phytobezoar removed laparoscopically. RESULTS The patient recovered well and was discharged home on the third postoperative day, tolerating a regular diet. CONCLUSIONS Phytobezoar impaction in a Meckel's diverticulum causing small bowel obstruction is a rare event. It can be effectively treated laparoscopically. This case provides an example of the potential utility of laparoscopy in treating small bowel obstructions of unclear etiology.
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Affiliation(s)
- Peter J Fagenholz
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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8
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Phytobezoar in Meckel's diverticulum: A rare cause of small bowel obstruction. Int J Surg Case Rep 2012; 3:161-3. [PMID: 22382033 DOI: 10.1016/j.ijscr.2012.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 12/21/2011] [Accepted: 01/25/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum (MD) is the prevailing anomaly of the gastrointestinal tract, found in about 2% of the population; it rarely gives rise to symptoms and its discovery is usually accidental. Phytobezoar is a concretion of poorly digested fruit and vegetable fibres that is found in the alimentary tract and rarely can be the cause of small intestinal obstruction. Herein we report a rare case of intestinal obstruction due to phytobezoar formation into a MD. PRESENTATION OF CASE A 50 year-old patient, was admitted to author's institution with an history of abdominal pain, nausea and multiples episodes of vomiting. Plain X-ray showed dilated small-bowel loops. Computed tomography (CT) revealed jejunal loops with air-fluid levels. The patient underwent explorative laparotomy where we found a giant Meckel's diverticulum, filled by a phytobezoar that caused small bowel compression. We performed a segmental ileal, resection, containing the MD. The histological exam confirmed Meckel's diverticulum. DISCUSSION Bowel obstruction due to a phytobezoar in a Meckel's diverticulum is rare: only 7 cases have been reported in literature. MD complications are rare and phytobezoar is one of them with only few cases described in literature. CONCLUSION The conventional x rays studies were inconclusive whereas abdominal contrast enhanced CT led to a definitive diagnosis. Explorative laparotomy or laparoscopy is mandatory in these cases.
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Duman L, Savas C, Ceyhan L. An unusual cause of intestinal obstruction in an infant: phytobezoar within a Meckel diverticulum. J Pediatr Surg 2011; 46:1678-9. [PMID: 21843742 DOI: 10.1016/j.jpedsurg.2011.03.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 03/29/2011] [Accepted: 03/30/2011] [Indexed: 11/15/2022]
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10
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Sharma RK, Jain VK. Emergency surgery for Meckel's diverticulum. World J Emerg Surg 2008; 3:27. [PMID: 18700974 PMCID: PMC2533303 DOI: 10.1186/1749-7922-3-27] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 08/13/2008] [Indexed: 12/13/2022] Open
Abstract
The current work attempts to highlight the various life threatening complications of Meckel's diverticulum and to present the surgical strategies used in the emergency conditions so far in the form of a review of the works presented in the literature. Our aim behind this presentation is to cover the possible indications, methods, their complications and the outcome of these surgical techniques. For this, we made an extensive literature search using Google and Pubmed with the words-"Meckel's diverticulum", "Complications", "Management" and "Emergency surgery". All the relevant articles containing the surgical aspects of symptomatic Meckel's diverticulum till May 2008 were collected and analyzed. Meckel's diverticulum is the remains of the prenatal yolkstalk (Vitellointestinal duct). Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge of its anatomical and pathophysiological properties to deal with such complications.
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Affiliation(s)
- Raj Kumar Sharma
- Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, India.
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11
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Stawicki SP, Kim PK, Pryor JP. Clinical challenges and images in GI. Small bowel obstruction caused by an intestinal phytobezoar. Gastroenterology 2007; 133:1767, 2077. [PMID: 18054547 DOI: 10.1053/j.gastro.2007.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Stanislaw P Stawicki
- Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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12
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Ha SS, Lee HS, Jung MK, Jeon SW, Cho CM, Kim SK, Choi YH. Acute intestinal obstruction caused by a persimmon phytobezoar after dissolution therapy with Coca-Cola. Korean J Intern Med 2007; 22:300-3. [PMID: 18309693 PMCID: PMC2687663 DOI: 10.3904/kjim.2007.22.4.300] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Seung Soo Ha
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun Suk Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Kyu Jung
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Chang Min Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sung Kook Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yong Hwan Choi
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
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13
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Dahshan A. Bleeding Meckel diverticulum responds to intravenous pantoprazole. South Med J 2007; 24:416-22. [PMID: 17396746 DOI: 10.1002/ca.21094] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 10/03/2010] [Accepted: 10/14/2010] [Indexed: 01/25/2023]
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Erzurumlu K, Malazgirt Z, Bektas A, Dervisoglu A, Polat C, Senyurek G, Yetim I, Ozkan K. Gastrointestinal bezoars: A retrospective analysis of 34 cases. World J Gastroenterol 2005; 11:1813-7. [PMID: 15793871 PMCID: PMC4305881 DOI: 10.3748/wjg.v11.i12.1813] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Bezoars (BZ) are the most common foreign bodies of gastrointestinal tract. Clinical manifestations vary depending on the location of BZ from no symptoms to acute abdominal syndrome. When located in small bowel, they frequently cause small bowel obstruction (SBO). We aimed to present our experience by reviewing literature.
METHODS: Thirty-four patients with gastrointestinal BZ were presented. The data were collected from hospital records and analyzed retrospectively. Morbidity and mortality rates were statistically analyzed between the subgroups according to SBO and endoscopic or surgical treatment modalities.
RESULTS: The 34 patients had phytobezoars (PBZ). Two patients with mental retardation and trichotillomania had trichobezoars (TBZ). More than half of them (55.88%) had previous gastric surgery. Also most of them had small bowel bezoars resulting in obstruction. Surgical and endoscopic morbidity rates were 32.14% and 14.28% respectively. The total morbidity rate of this study was 29.41%. Four patients in surgically treated group died. There was no death in endoscopically treated group. The total and surgical mortality rates were 11.76% and 14.28% respectively. The differences in morbidity and mortality rates between the subgroups were not statistically significant.
CONCLUSION: BZ are commonly seen in stomach and small intestine. SBO is the most common complication. When uncomplicated, endoscopic or surgical removal can be applied easily.
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Affiliation(s)
- Kenan Erzurumlu
- Department of Surgery, Medical School, Ondokuzmayis University, 55139 Kurupelit, Samsun, Turkey.
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Levy AD, Hobbs CM. From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation. Radiographics 2004; 24:565-87. [PMID: 15026601 DOI: 10.1148/rg.242035187] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 2%-3% of the population. It results from improper closure and absorption of the omphalomesenteric duct. Meckel diverticulum is the most common end result of the spectrum of omphalomesenteric duct anomalies, which also include umbilicoileal fistula, umbilical sinus, umbilical cyst, and a fibrous cord connecting the ileum to the umbilicus. The formation of Meckel diverticulum occurs with equal frequency in both sexes, but symptoms from complications are more common in male patients. Sixty percent of patients come to medical attention before 10 years of age, with the remainder of cases manifesting in adolescence and adulthood. Heterotopic gastric and pancreatic mucosa are frequently found histologically within the diverticula of symptomatic patients. The most common complications are hemorrhage from peptic ulceration, small intestinal obstruction, and diverticulitis. Although the clinical, pathologic, and radiologic features of the complications of Meckel diverticulum are well known, the diagnosis of Meckel diverticulum is difficult to establish preoperatively.
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Affiliation(s)
- Angela D Levy
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC 20306-6000, USA.
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Barbary C, Tissier S, Floquet M, Régent D. Imagerie des complications du diverticule de Meckel. ACTA ACUST UNITED AC 2004; 85:273-9. [PMID: 15192518 DOI: 10.1016/s0221-0363(04)97578-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Meckel's diverticulum is a persistent embryonic remnant occurring in 2% of the general population. As an "ileal appendix", it is usually clinically silent and only discovered at the time of complications: inflammation, hemorrhage, obstruction, tumor. The preoperative diagnosis is rarely made because of the non specific nature of the symptomatology and only about 10% of complicated cases are diagnosed at imaging. Complications from Meckel's diverticulum should always be considered in patients presenting with an acute abdomen, especially in young adults.
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Affiliation(s)
- C Barbary
- Service de Radiologie, Hôpital d'adultes, CHU Nancy Brabois, rue du Morvan, 54500 Vandoeuvre
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Abstract
Meckel's diverticulum is an uncommon cause of acute abdominal pain and small bowel obstruction in adults. We present a case of a 31-yr-old man with recurrent vomiting and abdominal pain in whom the diagnosis of Meckel's diverticulum was not suspected until CT of the abdomen revealed multiple fluid-filled, dilated loops of ileum with distal collapse after normal abdominal radiographs. We suggest that CT may be helpful when the diagnosis of Meckel's diverticulum is suspected.
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Affiliation(s)
- R T Prall
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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18
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Emparan C, Ortiz J, Iturburu I, Bilbao JE, Mendez J. Acute necrotizing Meckel diverticulitis due to biliary enterolithiasis. Dig Surg 2000; 15:369-71. [PMID: 9845616 DOI: 10.1159/000018634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Acute abdominal pain due to complicated Meckel's diverticulum is an unusual event. Even the presence of biliary enterolithiasis at the onset of inflamed congenital diverticulum has rarely been reported previously. RESULTS Despite this unusual presentation, an episode of gallstone passage through the biliary tract has not yet been described. CONCLUSIONS Whether the stones were primarily formed in the diverticulum as enterolithiasis, or secondary to gallstone passage is discussed. The complications of Meckel's diverticulum requiring surgical treatment are reviewed, focusing on the unusual finding of biliary stones in Meckel's diverticulum and the etiogenic mechanism of enterolithiasis.
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Affiliation(s)
- C Emparan
- Department of Surgery, Facultad de Medicina, Universidad del País Vasco, Bilbao, Vizcaya, Spain
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Kleiner O, Cohen Z, Finaly R, Mordehai J, Mares AJ. Unusual presentation of omphalomesenteric duct remnant: a variant of mesodiverticular band causing intestinal obstruction. J Pediatr Surg 2000; 35:1136-7. [PMID: 10917317 DOI: 10.1053/jpsu.2000.7847] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two unusual cases of small bowel obstruction associated with an omphalomesenteric duct remnant are described in 2 girls aged 14 years. The causative factor was a stenotic area in the terminal ileum caused by a ringlike lipovascular mesenteric band encroaching externally on the lumen. A phytobezoar was lodged proximally. This is as yet an undescribed variant of a mesodiverticular band.
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Affiliation(s)
- O Kleiner
- Department of Pediatric Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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20
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Gayer G, Jonas T, Apter S, Zissin R, Katz M, Katz R, Amitai M, Hertz M. Bezoars in the stomach and small bowel--CT appearance. Clin Radiol 1999; 54:228-32. [PMID: 10210341 DOI: 10.1016/s0009-9260(99)91156-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM The aim of this study was to present the computed tomography (CT) appearance of trichobezoars, phytobezoars and other unusual ingested material. MATERIALS AND METHODS Seven patients diagnosed on CT with bezoars in the stomach or small intestine were reviewed with special attention on the characteristics of the intraluminal mass and the presence of proximal dilatation. RESULTS There were six women and one man aged 14-81 years. CT was performed because of abdominal pain and a palpable abdominal mass. In none of the cases was the diagnosis suspected clinically. Four patients had a trichobezoar occupying the entire lumen of the stomach. It appeared as a concentric inhomogeneous mass with entrapped air, surrounded by contrast material. In the other three patients the bezoar was confined to the small intestine and was composed respectively of vegetable fibres, ingested toilet paper and an olive stone. The first two had a mottled appearance whereas the last one was small, spherical and well defined. Variable proximal dilatation of the small bowel was present in all three. CONCLUSION With the increased use of CT in the evaluation of patients with non-specific abdominal pain, it is important to recognize the CT appearance of bezoars, as this diagnosis is often not suspected clinically.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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