Discussing treatment strategies for acute mechanical intestinal obstruction caused by phytobezoar: A single-center retrospective study

BACKGROUND: This study aims to discuss management strategies regarding phytobezoar induced ileus based upon clinical results.
METHODS: In the present study, between December 2012 and December 2018, a total of 25 patients who were diagnosed with phytobezoar were evaluated retrospectively. Patients who had acute mechanical intestinal obstruction due to phytobezoars at different segments of gastrointestinal (GI) tract were included in this study. The clinical data (such as clinical findings, laboratory results, radiological evaluations, treatment methods) of the patients were examined.
RESULTS: Twenty five patients were included in this study. Of the 25 patients, 13 were women (52%). The median age was 60 (31–84) years, and the overall median length of the stay was 7 (2–28) days. Previous abdominal surgery had been recorded for 13 patients (72%). Two patients (8%) were followed up conservatively, whereas 20 (80%) patients had needed surgical intervention. One (4%) patient underwent surgery for distal ileal obstruction due to the pieces of bezoar that crumbled with previous endoscopic intervention. Three of the patients had complications, such as surgical site infection, wound dehiscence and paralytic ileus in the postoperative period. There were no differences between milking and gastrotomy/enterotomy groups according to the length of stay and postoperative complications. One patient died on the 13th postoperative day due to multi-organ failure. The mortality rate was 4%.
CONCLUSION: Phytobezoars, which are common with many other different surgical entities, can be located at any segment of the gastrointestinal tract and may cause obstruction, strangulation and/or even perforation. Contrast-enhanced CT scan must be performed in case of suspicion and to rule out any other causes of acute mechanical intestinal obstruction. Conservative and endoscopic procedures may be useful for selected patients, but the surgical treatment may be needed for the vast majority of the patients with phytobezoar. The surgery is safe for phytobezoar if the enterotomy site is chosen wisely.

Fitobezoara baðlý akut mekanik intestinal obstrüksiyon için tedavi stratejilerinin tartýþýlmasý: Tek merkezli geriye dönük bir çalýþma

AMAÇ: Bu çalýþmanýn temel amacý, fitobezoarýn neden olduðuý ileus ile ilgili klinik sonuçlara dayanan tedavi stratejilerini tartýþmaktýr.
GEREÇ VE YÖNTEM: Aralýk 2012 ve Aralýk 2018 yýllarý arasýnda fitobezoar tanýsý alan toplam 25 hasta geriye dönük olarak deðerlendirildi. Farklý seviyelerde gastrointestinal (GI) týkanýklýða yol açmýþ fitobezoarlara baðlý akut mekanik baðýrsak obstrüksiyonu olan hastalar çalýþmaya alýndý. Hastalarýn klinik verileri (klinik bulgular, laboratuvar sonuçlarý, radyolojik deðerlendirmeler, tedavi yöntemleri) deðerlendildi.
BULGULAR: Çalýþmaya 25 hasta dahil edildi. Yirmi beþ hastanýn 13’ü kadýndý (%52). Ortanca yaþ 60 (31–84) yýldý ve toplam ortanca kalýþ süresi yedi (2–28) gündü. On üç hastada (%72) geçirilmiþ abdominal cerrahi olduðu tespit edildi. Ýki hasta (%8) konservatif olarak takip edildi, 20 (%80) hastaya cerrahi müdahale gerekti. Bir hastaya (%4) önceki endoskopik giriþim ile parçalanan bezoar parçalarý yüzünden oluþan distal ileal obstrüksiyon nedeniyle cerrahi giriþim uygulandý. Ameliyat sonrasý dönemde hastalarýn üçünde cerrahi alan enfeksiyonu, yara ayrýlmasý ve ameliyat sonrasý ileus gibi komplikasyonlar geliþtiði saptandý. Sadece milking yapýlan grup ile gastrotomi/enterotomi gruplarý arasýnda hastanede yatýþ süresi ve ameliyat sonrasý komplikasyonlar açýsýndan fark olmadýðý saptandý. Bir hasta ameliyat sonrasý 13. günde çoklu organ yetersizliði nedeniyle öldü. Mortalite oraný %4 olarak saptandý.
TARTIÞMA: Fitobezoar kaynaklý akut mekanik baðýrsak týkanýklýðý ile baþvuran seçilmiþ olgularda konservatif yaklaþým uygulanarak, önemli cerrahi müdahale gerekmeksizin uygun klinik iyileþme saðlanabilir. Ancak konservatif tedaviye yanýt alýnamayan olgularda cerrahi tedavi mutlaka göz önünde bulundurulmalýdýr. Enterotomi yapýlan baðýrsak segmentinin dikkatlice seçilmesi güvenli cerrahi için önemlidir.