diospyros and Bezoars

Gastric bezoars are concretions of undigested material, and Coca-Cola therapy is an easy, efficacious and safe approach for bezoar treatment. Gastric outlet obstruction due to a migratory gastric bezoar during Coca-Cola therapy is an uncommon presentation and, to the best of our knowledge, no cases have been previously reported. We herein describe one such case with no known predisposing factors that recovered via the endoscopic technique. A thorough literature search was performed, which yielded eight relevant patients from seven publications, all of who developed gastrointestinal obstruction during dissolution treatment and recovered uneventfully after surgical intervention. In conclusion, this potential complication should be kept in mind in the event that alternative treatment is necessary.

Topics: Abdominal Pain; Aged, 80 and over; Bezoars; Carbonated Beverages; Cola; Diospyros; Endoscopy; Female; Gastric Outlet Obstruction; Humans; Radiography; Therapeutic Irrigation; Treatment Outcome

We reported a case of huge gastric phytobezoar. The gastric phytobezoar was successfully removed through gastrotomy after two failed attempts in endoscopic fragmentation and removal. Disopyrobezoars could be treated either conservatively or surgically. Gastrotomy or laparoscopical management is recommended for the treatment of huge disopyrobezoars.

Topics: Bezoars; Diospyros; Humans; Male; Middle Aged; Radiography; Stomach

Topics: Bezoars; Digestive System; Diospyros; Esophageal Diseases; Fruit; Gastric Acid; Humans

Topics: Bezoars; Diospyros; Fruit; Humans; Intestinal Obstruction

Topics: Adult; Bezoars; Diospyros; Female; Humans; Intestinal Obstruction; Intestine, Small; Stomach; Treatment Outcome

Topics: Aged, 80 and over; Bezoars; Carbonated Beverages; Diospyros; Endoscopy, Digestive System; Humans; Male

Topics: Aged; Bezoars; Diospyros; Fruit; Humans; Intestinal Obstruction; Intestine, Small; Male

Owing to their rare occurrence, persimmon bezoars are often overlooked as a cause of small bowel obstruction. We herein report a small bowel obstruction in a 67-year-old Japanese female who regularly consumed persimmons in autumn. The patient presented to our hospital with typical complaints of abdominal distension with pain for 2 days. Based on the patient's history of a cesarean section 34 years ago, we initially diagnosed her with small bowel obstruction resulting from adhesions and placed an ileus tube. At first, the patient rejected the operation in spite of our recommendation. After 10 days, because the ileus tube was unable to relieve the obstruction, finally surgery was scheduled. Upon releasing the obstruction by partial resection of the small bowel, we found an impacted bezoar without any evidence of adhesions. After stone analysis, we first realized her regular persimmon intake. This case serves as an important reminder to obtain dietary history in order to investigate all possible causes of small bowel obstruction when intestinal obstruction is suspected.

Topics: Aged; Bezoars; Diagnosis, Differential; Diospyros; Female; Humans; Intestinal Obstruction; Intestine, Small; Radiography, Abdominal

Topics: Aged; Bezoars; Carbonated Beverages; Cellulase; Diospyros; Humans; Male; Papain; Solubility; Stomach

Topics: Aged; Bezoars; Diospyros; Humans; Male; Microscopy, Electron, Scanning; Stomach

Diospyrobezoars are a rare cause of small intestinal obstruction. A 78-year-old man, with a history of persimmons ingestion and gastrectomy, presented with upper abdominal pain and weight loss. The upper gastrointestinal endoscopy showed a huge bezoar in the stomach. After initial endoscopic fragmentation, the abdominal X-ray revealed intestinal obstruction and the colonoscopy showed large fragments of the bezoar filling the terminal ileum. The migrated bezoar pieces were successfully removed by endoscopic fragmentation with a cutting lithotripter.

Topics: Aged; Bezoars; Diagnosis, Differential; Diospyros; Endoscopy, Gastrointestinal; Foreign-Body Migration; Humans; Intestinal Obstruction; Intestine, Small; Male; Radiography, Abdominal; Stomach

Intestinal obstruction is a common clinical entity encountered in surgical practice. The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on the diagnosis and treatment. A 27-year-old male presented with a history of gastric pain combined with nausea and abdominal distension that had been present for 5 d. The presence of a foreign body was detected by computed tomography and observed as an abnormal density within the stomach. A diospyrobezoar was revealed during gastroscopy, the extraction of which was prevented due to its size and firmness. An endoscopic holmium laser joined with a snare was used to fragment the obstruction, which was followed by management with a conservative "sandwich" treatment strategy involving intestinal decompression with an ileus tube and Coca-Cola lavage between endoscopic lithotripsy fragmentation procedures. This strategy resulted in the successful removal of the diospyrobezoar along with multiple small bowel obstructions. The patient was discharged after abatement of symptoms. The case presented here demonstrates the implementation of a conservative, yet successful, treatment as an alternative to conventional surgical removal of intestinal obstructions.

Topics: Adult; Bezoars; Carbonated Beverages; Decompression, Surgical; Diospyros; Gastroscopy; Humans; Intestinal Obstruction; Lasers, Solid-State; Lithotripsy, Laser; Male; Therapeutic Irrigation; Tomography, X-Ray Computed; Treatment Outcome

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.

Topics: Animals; Bezoars; Diospyros; Fatal Outcome; Female; Herpestidae; Male

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.

Topics: Animals; Bezoars; Diospyros; Endoscopy, Gastrointestinal; Equidae; Female; Fruit; Gastrointestinal Diseases; Gastroscopy; Male

Topics: Bezoars; Diospyros; Gastric Outlet Obstruction; Humans; Male; Middle Aged; Seeds

Gastric bezoars may be formed in the stomach as a result of foreign body accumulation with inability to pass through the pylorus. Usually bezoars are found in patients with a history of previous gastric surgery. Phytobezoars are the most common type of bezoars. Major complications of bezoars include intestinal obstruction, gastric ulcer, gastric perforation, and bleeding. We present the case of a 51-year-old woman with the features of gastrointestinal bleeding due to a giant diospyrobezoar in the stomach. During endoscopy besides the bezoar, a giant acute ulcer was found. Histological examination of biopsy specimens from ulcer area revealed changes typical of superficial ischemic damage due to prolonged bezoar compression. The patient had undergone a vagotomy and pyloroplasty 13 years ago, and she used to eat two or three persimmons per week during the last six months. The bezoar was fragmented during two endoscopies, and the fragments drifted away through the intestine. We conclude that delayed gastric emptying due to previous gastric surgery and regular eating of persimmons caused the formation of a giant bezoar with ischemic ulcer of gastric mucosa and bleeding. Such pathology potentially could be prevented by dietary advice.

Topics: Acute Disease; Bezoars; Biopsy; Diospyros; Endoscopy; Female; Gastric Emptying; Gastrointestinal Hemorrhage; Humans; Middle Aged; Stomach Ulcer

Topics: Aged, 80 and over; Bezoars; Diospyros; Gastrointestinal Hemorrhage; Humans; Male; Stomach; Stomach Ulcer

Topics: Aged; Bezoars; Colonic Diseases; Diospyros; Female; Gastrointestinal Hemorrhage; Humans

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.

Topics: Acute Disease; Aged; Bezoars; Carbonated Beverages; Cola; Diospyros; Endoscopy, Gastrointestinal; Humans; Intestinal Obstruction; Intestine, Small; Male; Risk Factors

A diospyrobezoar is a type of phytobezoar that is considered to be harder than any other types of phytobezoars. Here, we describe a new treatment modality, which effectively and easily disrupted huge gastric diospyrobezoars. A 41-year-old man with a history of diabetes mellitus was admitted with lower abdominal pain and vomiting. Upper gastrointestinal endoscopy revealed three huge, round diospyrobezoars in the stomach. He was made to drink two cans of Coca-Cola every 6 h. At endoscopy the next day, the bezoars were partially dissolved and turned to be softened. We performed direct endoscopic injection of Coca-Cola into each bezoar. At repeated endoscopy the next day, the bezoars were completely dissolved.

Topics: Administration, Oral; Adult; Bezoars; Carbonated Beverages; Diospyros; Endoscopy; Humans; Male; Stomach Diseases

Topics: Bezoars; Diospyros; Humans; Intestinal Obstruction; Jejunal Diseases; Male; Middle Aged; Vitamin B 12 Deficiency

Topics: Beverages; Bezoars; Diospyros; Female; Gastric Lavage; Humans; Intubation, Gastrointestinal; Middle Aged

To present the clinical picture of small bowel obstruction caused by Persimmon phytobezoars in children of Hazara (Northern Pakistan).. Descriptive case series.. Three general surgical units of Ayub Teaching Hospital, Abbottabad from November 1998 to March 2003.. Nineteen children were managed for small bowel obstruction due to persimmon phytobezoars. The age, gender, season at the time of presentation, history of persimmon ingestion, symptoms, signs, site of obstruction, operative procedure and outcome were analyzed.. There were 15 males and 4 females with ages ranging from 4-11 years (mean 7 years). All presented in winter with a positive history of persimmon ingestion. All had signs and symptoms and evidence of small bowel obstruction on plain abdominal x-rays. At laparotomy, ileum was the commonest site of obstruction. Milking of bezoars into caecum was performed in 17 patients while 2 patients required enterotomy for removal of bezoars. Complications occurred in 4 patients. There was no mortality.. Small bowel obstruction in children due to persimmon phytobezoars is uncommon. However, it should be considered pre-operatively as a possible cause of intestinal obstruction in winter in children who have access to the fruit. Laparotomy should be performed for persistent obstruction or signs of strangulation.

Topics: Bezoars; Child; Child, Preschool; Digestive System Surgical Procedures; Diospyros; Female; Humans; Intestinal Obstruction; Intestine, Small; Male; Treatment Outcome

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.. 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.. Resolution was achieved in 8 patients. Complications (intestinal obstruction) developed in 2 patients.. 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.

Topics: Bezoars; Cellulase; Combined Modality Therapy; Cysteine; Diospyros; Endoscopy, Gastrointestinal; Female; Gastrointestinal Agents; Humans; Male; Metoclopramide; Middle Aged; Stomach

Topics: Alkalies; Bezoars; Digestive System; Diospyros; Flavoring Agents; Foreign Bodies; Fruit; Gastrointestinal Diseases; Humans; Radiography

Topics: Bezoars; Diagnosis, Differential; Digestive System; Diospyros; Foreign Bodies; Fruit; Gastrointestinal Diseases; Gastroscopy; Geriatrics; Humans; Radiography; Stomach Neoplasms; Surgical Procedures, Operative

Topics: Bezoars; Diospyros; Fruit; Gastrointestinal Diseases; Humans; Intestinal Obstruction; Medical Records

Topics: Bezoars; Digestive System; Diospyros; Foreign Bodies; Fruit; Gastrointestinal Diseases; Humans; Medical Records

Topics: Bezoars; Digestive System; Diospyros; Foreign Bodies; Gastrointestinal Diseases; Humans; Intestinal Obstruction; Medical Records

Topics: Bezoars; Diospyros; Foreign Bodies; Gastrointestinal Diseases; Humans; Stomach

Topics: Bezoars; Digestive System; Diospyros; Gastrointestinal Diseases; Gastroscopy; Humans; Peptic Ulcer; Stomach Ulcer