Phytobezoars of gastrointestinal system

Purpose: Gastric and/or small intestinal phytobezoar are rare but occasionally apply with acute abdomen findings. In our study, we aimed to determine diagnosis and treatment approach for gastric and/or small intestinal phytobezoar.
Material and Method: Data of the patients operated for phytobezoar between december 1999-november 2010 were evaluated retrospectively. Age, sex, previous operations, comorbid disease, complaintments and treatments of the patients were studied.
Results: Sum of the patients were 6 (4 female and 2 male) and mean age of the patients was 63,3 year. Four of the patients were admitted to emergency service, 2 were admitted to policlinics with elective course. Two of the patients were operated for peptic ulcus perforations, and 1 patients has diabetes mellitus (DM). Abdominal ultrasonography (USG) was performed for 2 patients, and abdominal computed tomography (CT) was performed for 2 patients, but phytobezoars not diagnosed with radiologically in non of the patients. Phytobezoars were diagnosed with endoscopy before the operation in 3 patients. Phytobezoars are not suitable for endoscopic treatment so the patients have gone to operation. In the operation, gastric phytobezoars was removed with gastrotomy in 2 patients, gastric and intestinal phytobezoars removed with gastrotomy and enterotomy 1 patient and intestinal phytobezoar was removed with enterotomy in 2. Segmenter small intestinal resection was performed and phytobezoar was removed in the patient with intestinal perforation. Patient was discarged from
the hospital mean 7 days without postoperatif complication.
Conclusion: Phytobezoars was the rare cause of intestinal obstructions. Phytobezoars should be remembered in the patients with intestinal obtruction findindings and gastric-duodenal operation history.

Gastrointestinal sistem fitobezoarlarý

Amaç: Mide ve/veya ince baðýrsak fitobezoarlarý nadir görülmekte ve zaman zaman akut batýn bulgularý ile kar- þýmýza çýkmaktadýr. Çalýþmamýzda mide ve/veya ince baðýrsak fitobezoarlarýna yönelik taný ve tedavi yaklaþýmýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Aralýk 1999-Kasým 2010 tarihleri arasýnda fitobezoar nedeniyle ameliyat edilen hastalarýn kayýtlarý retrospektif olarak deðerlendirildi. Bu hastalarýn yaþlarý, cinsiyetleri, daha önce geçirmiþ olduklarý ameliyatlar, ek hastalýklarý, baþvuru þikayetleri ve uygulanan tedavi yöntemleri incelendi.
Bulgular: Toplam hasta sayýsý 6 (4 kadýn, 2 erkek) olup, hastalarýn yaþ ortalamasý 63,3 yýl idi. Hastalardan 4’ü acil servise, 2’si ise elektif olarak polikliniðe baþvurmuþlardý. Ýki hasta peptik ülser perforasyonu nedeniyle ameliyat edilmiþ olup 1 hastada Diyabetes Mellitus (DM) var idi. Ýki hastaya batýn ultrasonografi (USG), 2 hastaya ise bilgisayarlý batýn tomografisi (BT) çekildi; ancak hiçbirinde fitobezoar tanýsý radyolojik olarak konulamadý. Üç hastaya ameliyat öncesi yapýlan gastroskopide mide fitobezoarý görüntülendi. Fitobezoarlar endoskopik tedaviye uygun olmadýðýndan cerrahi tedavi uygulandý. Ameliyatta 2 hastadaki mide fitobeozarlarý gastrotomi ile, 1 hastadaki mide ve incebarsak fitobezoarlarý gastrotomi ve enterotomi ile, 2 hastadaki incebarsak fitobezoarlarý enterotomi ile çýkarýldý. Ýncebarsak perforasyonu olan hastada segmenter incebarsak rezeksiyonu uygulandý ve fitobezoar çýkarýldý. Ameliyat sonrasý komplikasyon gözlenmeyen hastalar ortalama 7. günde taburcu edildiler.
Sonuç: Fitobezoarlar mekanik barsak týkanýklýðýnýn ender nedenlerindendir. Özellikle geçirilmiþ mide ve duodenum ameliyatý öyküsü olan ve incebarsak týkanýklýðý bulgularýyla baþvuran hastalarda fitobezoarlar da akla gelmelidir.