Phytobezoar-Induced Small Bowel Obstruction: Report of a Case

小腸阻塞最常見的原因包括腹膜黏連、絞窄性疝氣、或鄰近的腫瘤壓迫腸所致。因植物性糞石所引起之小腸阻塞在急性腹痛的患者中則相當少見。大多數植物性糞石的生成與患者食用柿子有關；尤其是以那些曾經接受過胃部手術或患有系統性疾病合併自主神經病變及胃排空時間延長的患者為然。我們報告一位59歲女性患者，因為肚臍周圍疼痛、嘔吐及五天未解大便住院。患者過去健康情形良好，在住院前半年內也沒有吃過柿子。小腸鋇劑攝影檢查顯示在距離Treitz韌帶以下約80公分處的中段空腸有機械性阻塞。患者因內科治療失敗而接受剖腹探查，結果發現一個8×3×3公分大的糞石位於與小腸鋇劑檢查相吻合的阻塞部位，並經由腸切開術將之取出。患者經過手術治療後病情穩定而出院。在本文中我們將提出植物性糞石引起之腸胃道阻塞的各種治療策略，對於容易發病的患者，我們也提出一些預防的方法。

關鍵字

植物性糞石；小腸阻塞

並列摘要

The most common causes of the small bowel obstruction are adhesive bands, incarcerated hernia and adjacent tumor. Small bowel obstruction caused by phytobezoars, however is quite uncommon in patients suffering from acute abdomen. Most phytobezoar formation is related to the patient ingestion of persimmon, especially those with previous gastric surgery, autonomic neuropathy or delayed gastric emptying time. We report a 59-year-old female patient admitted due to periumbilical pain, vomiting and no stool passage for 5 days. She was well in the past and had never eaten persimmon for at least half a year prior to admission. Small bowel barium meal examination revealed a mechanical obstruction over middle jejunum about 80cm below Treitz's ligament. The patient underwent exploratory laparotomy after failure of medical treatment. A bezoar 8×3×3cm in size, was lodged and extracted via enterotomy over the compatible obstruction site of barium meal examination. Pathology result confirmed the bezoar to be a phytobezoar: After surgical treatment, the patient was discharged in a stable condition. This case report will attempt to present the treatment strategy of phytobezoar-induced gastrointestinal obstruction and propose certain measures for the prevention of phytobezoar formation in vulnerable patients.

並列關鍵字

Phytobezoar ； small bowel obstruction

國際替代計量

Phytobezoar-Induced Small Bowel Obstruction: Report of a Case

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