Krausz M M, Moriel E Z, Ayalon A, Pode D, Durst A L
Am J Surg. 1986 Nov;152(5):526-30. doi: 10.1016/0002-9610(86)90221-7.
One hundred thirteen patients presented with gastrointestinal complications due to persimmon phytobezoars during a 3 year period. One hundred three patients had a history of persimmon ingestion. One hundred five patients had undergone previous gastric operation for duodenal ulcer, one patient underwent highly selective vagotomy, and seven patients had not undergone previous operation. An elevated temperature, leukocytosis, and decreased bowel sounds were typical early clinical manifestations of small bowel obstruction by persimmon phytobezoars. In 13 patients, gastric bezoars were found, in 20 patients, gastric and intestinal bezoars, and in 80 patients, intestinal bezoars. One hundred patients were treated surgically. In 14 of the 20 patients with concomitant gastric and intestinal phytobezoars, extraction of the bezoars was achieved by gastrotomy. Of the remaining six patients, it was achieved by intraoperative milking of the gastric bezoar into the small bowel in two patients and by conservative treatment in four patients. Of the 100 patients who presented with small bowel obstruction, 60 were treated by milking of the bezoar into the large bowel, 34 by enterotomy, and 6 by conservative therapy with intravenous fluids, gastric suction, and a water-soluble contrast meal. Small bowel resection of a gangrenous segment was necessary in two patients. Two patients died after operation because of sepsis and respiratory complications. Eleven of the 13 patients in whom postoperative wound infection developed underwent gastrotomy or enterotomy. We conclude that the treatment of choice of intestinal obstruction due to persimmon phytobezoars is milking of the bezoar into the large bowel without enterotomy. Preoperative or operative endoscopy should be performed in patients presenting with complications of gastrointestinal phytobezoars. Patients who have undergone gastric operation should be warned against the risk of persimmon ingestion.
在3年期间，113例患者因柿子植物性胃石出现胃肠道并发症。103例患者有食用柿子的病史。105例患者曾因十二指肠溃疡接受过胃手术，1例患者接受了高选择性迷走神经切断术，7例患者未曾接受过手术。体温升高、白细胞增多和肠鸣音减弱是柿子植物性胃石导致小肠梗阻的典型早期临床表现。13例患者发现有胃石，20例患者有胃和肠石，80例患者有肠石。100例患者接受了手术治疗。在20例同时有胃和肠植物性胃石的患者中，14例通过胃切开术取出胃石。其余6例患者中，2例通过术中将胃石挤入小肠，4例通过保守治疗。在100例出现小肠梗阻的患者中，60例通过将胃石挤入大肠治疗，34例通过肠切开术治疗，6例通过静脉输液、胃肠减压和水溶性造影剂餐的保守治疗。2例患者需要切除坏死的小肠段。2例患者术后因败血症和呼吸并发症死亡。术后伤口感染的13例患者中有11例接受了胃切开术或肠切开术。我们得出结论，柿子植物性胃石导致的肠梗阻的首选治疗方法是将胃石挤入大肠而不进行肠切开术。出现胃肠道植物性胃石并发症的患者应进行术前或术中内镜检查。接受过胃手术的患者应被告知食用柿子的风险。
