Surgical Management of Intestinal Obstruction from Phytobezoar

Tang, Man Hon; Heng, Gregory

Abstract

PURPOSE
Phytobezoar is the most common type of bezoar, which can occasionally present as an intestinal obstruction. In this study, the surgical experience and outcome in the management of intestinal obstruction caused by bezoars are described.
METHODS
A retrospective analysis of all operative cases of bezoars (n = 36) at Khoo Tech Puat hospital between 2011-2017 was performed. Patient demographics, imaging and operative findings, characteristics of bezoars and related morbidities were analyzed. The study population was subdivided into 2 groups based on operative intervention (fragmentation and milking of bezoars, versus enterotomy and/or bowel resection).
RESULTS
There were 36 cases of bezoars in 35 patients that were included in this study. Computed tomography scans were diagnostic of bezoars in 27 cases (75%). There were 20 cases (55.6%) that underwent fragmentation and milking of bezoars. The remaining 16 cases (44.4%) required an enterotomy or bowel resection. Bezoars that required enterotomy / bowel resection were more likely to be distally located in the ileum (75% vs 40%, p = 0.01), larger in volume (86.5 mL vs 63 mL, p = 0.04), with significant increase in morbidity rates (43.8% vs 5%, p < 0.01) compared with all other cases of bezoars.
CONCLUSION
Risk factors for enterotomy / bowel resection in bezoar bowel obstruction include, non-diagnostic computed tomography scans, distally located, and larger volumes of bezoars. Fragmentation and milking should be attempted first as it has lower morbidity rates than enterotomy / bowel resection surgery.