Gök Ali Fuat Kaan, Sönmez Recep Erçin, Kantarcı Tarık Recep, Bayraktar Adem, Emiroğlu Selman, İlhan Mehmet, Güloğlu Recep
Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey.
Department of General Surgery, İstanbul Medeniyet University Faculty of Medicine, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2019 Sep;25(5):503-509. doi: 10.14744/tjtes.2019.24557.
This study aims to discuss management strategies regarding phytobezoar induced ileus based upon clinical results.
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.
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%.
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.
本研究旨在基于临床结果探讨植物性粪石所致肠梗阻的管理策略。
在本研究中，对2012年12月至2018年12月期间共25例诊断为植物性粪石的患者进行回顾性评估。纳入因不同胃肠道段植物性粪石导致急性机械性肠梗阻的患者。检查患者的临床资料（如临床表现、实验室检查结果、影像学评估、治疗方法）。
本研究共纳入25例患者。25例患者中，13例为女性（52%）。中位年龄为60（31 - 84）岁，总体中位住院时间为7（2 - 28）天。13例患者（72%）有腹部手术史。2例患者（8%）接受保守治疗，2（80%）例患者需要手术干预。1例患者（4%）因先前内镜干预后粪石破碎导致回肠末端梗阻而接受手术。3例患者术后出现手术部位感染、伤口裂开和麻痹性肠梗阻等并发症。根据住院时间和术后并发症，按摩组与胃切开术/肠切开术组之间无差异。1例患者术后第13天因多器官功能衰竭死亡。死亡率为4%。
植物性粪石与许多其他不同的外科疾病一样常见，可位于胃肠道的任何部位，并可能导致梗阻、绞窄甚至穿孔。怀疑时必须进行增强CT扫描以排除急性机械性肠梗阻的任何其他原因。保守和内镜治疗可能对部分患者有用，但绝大多数植物性粪石患者可能需要手术治疗。如果明智地选择肠切开部位，手术治疗植物性粪石是安全的。
