Hayes P G, Rotstein O D
Can J Surg. 1986 Nov;29(6):419-20.
A chart review from 1975 to 1985 at the Toronto Western Hospital identified 16 patients (9 women and 7 men, between the ages of 39 and 83 years) with gastrointestinal phytobezoars. Nine had previously undergone vagotomy and drainage procedures. There were two distinct clinical groups, dependent on the location gastric bezoars presented with chronic burning epigastric pain and nausea and vomiting in addition to anorexia and weight loss. Six of seven patients with small-bowel bezoars had acute small-bowel obstruction, manifested by crampy abdominal pain, vomiting and obstipation. In the seventh patient the bezoar was found incidentally in an efferent loop during endoscopy. Gastric bezoars were all diagnosed by endoscopy; patients with small-bowel bezoars had x-ray films compatible with small-bowel obstruction. The obstructing small-bowel bezoars were found at midileum and proximal jejunum. Five patients underwent proximal enterotomy with bezoar removal; in one the bezoar was milked distally into the cecum. One patient also had multiple nonobstructing small-bowel bezoars removed through the single enterotomy and another had a separate gastrotomy for removal of a gastric bezoar. The postoperative courses were uncomplicated except for wound infection in one patient. None of the patients with an isolated gastric bezoar required surgery. Three patients were successfully treated with gastric lavage and the others with clear fluid diet.
对多伦多西部医院1975年至1985年期间的病历进行回顾，发现了16例患有胃肠道植物性粪石的患者（9名女性和7名男性，年龄在39岁至83岁之间）。其中9例患者此前接受过迷走神经切断术和引流手术。根据粪石的位置分为两个不同的临床组，胃粪石患者除了厌食和体重减轻外，还伴有慢性上腹部灼痛、恶心和呕吐。7例小肠粪石患者中有6例出现急性小肠梗阻，表现为腹部绞痛、呕吐和便秘。第7例患者在内镜检查时偶然在输出袢中发现粪石。胃粪石均通过内镜诊断；小肠粪石患者的X光片显示与小肠梗阻相符。梗阻性小肠粪石位于回肠中部和空肠近端。5例患者接受了近端肠切开取石术；其中1例将粪石向远端挤入盲肠。1例患者还通过单次肠切开术切除了多个非梗阻性小肠粪石，另1例患者通过单独的胃切开术切除了胃粪石。除1例患者出现伤口感染外术后过程均无并发症。单纯胃粪石患者均无需手术。3例患者通过洗胃成功治疗，其他患者通过清流饮食治疗。
