De Cesare Alessandro, Fiori Enrico, Bononi Marco, Ferraro Daniele
Ann Ital Chir. 2015 Jan-Feb;86(1):70-7.
Bezoars are aggregates of indigested foreign material that accumulate in the gastroenteric tract, expecially in the stomach and in the narrowest points of the small bowel. They often occur in subjects who follow a diet rich in fruit and vegetables and in those one who previously underwent gastric resective surgery for peptic ulcer. Bezoar formation has even been observed in case of reduced gastric motility and secretion due to diabetes, hypothyroidism, pernicious anemia, myotonic syndromes, and Guillain-Barré syndrome. As they are an uncommon cause of small bowel obstruction, phytobezoars are often not considered in the differential diagnosis of occlusive intestinal syndromes and so frequently come as an intraoperative finding. A consequence of this missed diagnosis in the preoperative period is an unnecessary diagnostic delay that can significantly increase morbidity and mortality. This case report illustrates the need to include phytobezoars in the preoperative diagnostic workout of intestinal obstruction in order to rule out the presence of multiple bezoars and prevent recurrent obstruction. Now that phytobezoars are becoming a less infrequent cause of small bowel obstruction than previously thought, such a diagnostic possibility should always be considered.
胃石是积聚在胃肠道内的未消化异物聚集体，尤其多见于胃和小肠最狭窄处。胃石常发生于食用富含水果和蔬菜饮食的人群以及既往因消化性溃疡接受过胃切除手术的人群。在因糖尿病、甲状腺功能减退、恶性贫血、强直性肌营养不良综合征和吉兰 - 巴雷综合征导致胃动力和分泌减少的情况下，也观察到了胃石形成。由于植物性胃石是小肠梗阻的罕见原因，在闭塞性肠道综合征的鉴别诊断中常常不被考虑，因此经常在手术中才被发现。术前漏诊的后果是不必要的诊断延迟，这会显著增加发病率和死亡率。本病例报告说明了在肠梗阻的术前诊断检查中需要考虑植物性胃石，以排除多发胃石的存在并防止复发性梗阻。鉴于植物性胃石作为小肠梗阻原因的发生率比以前认为的更高，这种诊断可能性应始终被考虑。
