Amlookobezoar; a diospyrobezoar causing acute small bowel obstruction-A case series

Abstract

Abstract:Introduction: Bezoars are non-dissolved hard masses of undigested or partially digested food or foreign material that are trapped in the gastrointestinal tract. Bezoars are broadly classified into four groups, viz; phytobezoars, trichobezoar, lactobezoars, and pharmacobezoars. One of the common sub-types of phytobezoars is amlookobezoar (diospyrobezoar). Aims: To describe the clinical profile and treatment outcome of a series of patients of amlookobezoar presenting with small bowel obstruction.Methods: This prospective observational case-series study includes five patients of both sexes presenting with small bowel obstruction (SBO) caused due to amlookobezoar. All patients were evaluated with respect to detailed history, physical examination and radiological assessment to confirm the diagnosis. Radiological assessment included X-ray abdomen, USG and CECT abdomen. Results: We had total of five cases of SBO caused due to amlookobezoars. The age of these patients ranged from 8-years to 22-years with male-female ratio of 4:1. All the 5 patients in this series presented with the features of SBO in the autumn months. None of our patients had any other significant predisposing factor for bezoar formation except that all of these patients had taken significant amount of amlooks (persimmon fruit) 3-10days earlier. Four patients eventually required the exploratory laparotomy. All the four patients had soft to firm bezoars stuck up in distal or mid-ileum. Fortunately in all these 4 patients, we were able to manually breakdown the amlookobezoars and milk them down beyond the ileocaecal level without the need for any enterotomy, gut resection or creation of stoma. In all of the 4 operated patients, the postoperative period was almost uneventful. Conclusion: Though uncommon, but amlookobezoars should be considered as differential diagnosis in a case of small bowel obstruction. Amlookobezoars commonly affects young adolescent males in the autumn months and often needs a laparotomy with fragmentation and milking down of amlookobezoars.