Bezoar manifested with intestinal obstruction: A review of 20 cases

Bowel obstructions resulting from bezoars are occasionally encountered in general surgery. This is a retrospective review of 20 cases treated in the National Cheng Kung University hospital in the period July 1988 and September 1992. Of these, nine had either had prior gastric surgery (7) or peptic ulcers (2); these were categorized as Group I. The remaining 11 patients without above conditions were categorized as Group II; and 5 had a history of ingestion of Pho Zi (Celtis sinensis), 3 had food bolus ingestion, 1 had diverticulum, 1 had adhesions and the remaining 1 had no significant features. One patient, who had a failure of endoscopic removal of gastric bezoar and subsequently developed bowel obstruction, refused operation. Eleven of the 20 who underwent operation within 24 hours after arrival recuperated uneventfully and were discharged within 1 week. Eight patients had surgery after 24 hours required prolonged hospitalization (6) and resulted in death for 2. Reoperation was performed in one case for recurrence of obstruction by the residual bezoar. The conclusion that dietary factor (Pho Zi or bolus ingestion), and gastrointestinal (GI) anatomical lesion (diverticulum or adhesion) are profound etiologies for formation of bezoars in cases without previous gastric surgery. On the other hand, gastric factors (previous ulcer surgery or peptic ulcer) play a major role even after ingestion of nonspecific high fiber diet. Early diagnosis, surgical intervention without delay and thorough exploration of the entire GI tract are essential for good postoperative results.