Small-bowel obstruction secondary to bezoar impaction: A diagnostic dilemma
Identifieur interne : 001F74 ( Main/Exploration ); précédent : 001F73; suivant : 001F75Small-bowel obstruction secondary to bezoar impaction: A diagnostic dilemma
Auteurs : Thomas W. Ho [Singapour] ; Dean C. Koh [Singapour] ; Ahmad Assalia [Israël]Source :
- World journal of surgery [ 0364-2313 ] ; 2007.
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Abstract
Background: Gastrointestinal bezoar (GIB) is uncommon and is reported to occur in 4% of all admissions for small-bowel obstruction (SBO). Because of a lack of diagnostic features, it is often associated with a delay in treatment, with increased morbidity. In this article, we report our experience with managing bezoar-induced SBO and the role of early computed tomography (CT) imaging in establishing the diagnosis. Methods: We retrospectively reviewed all cases of bezoar-induced SBO treated in our unit between 1999 and 2005. Results: There were 43 patients, of whom 2 had a recurrence, giving a total of 45 episodes. The frequency of bezoar in our patients presenting with SBO was 4.3%. All patients were of Asian origin: 41 Chinese, 1 Indian, and 1 Malay. Twenty-eight (65%) patients had previous abdominal surgery of which 26 were gastric surgery. Thirty-eight (88%) patients were edentulous. Forty-one (91%) underwent serial abdominal radiography, whereas only 4 patients (9%) had either CT imaging or contrast study alone. Only 11 (24%) cases had a correct diagnosis of bezoar impaction made preoperatively by CT imaging. The diagnostic accuracy of CT imaging in our series was 65%, with six cases of misdiagnosis. Overall, CT led to a change in management of 76% (13 in 17). The median time to surgery from admission was 2 (0-10) days. There were 2 cases of ischemic bowel that necessitated bowel resection. The median length of hospital stay was 11 (5-100) days. Ten patients (22%) had postoperative complications, and there was one death. Conclusion: Bezoar-induced SBO is uncommon and remains a diagnostic and management challenge. It should be suspected in patients with an increased risk of formation of GIB, such as previous gastric surgery, poor dentition, and a suggestive history of increased fibre intake. We advocate that CT imaging be performed early in these at-risk patients and in patients presenting with SBO with or without a history of abdominal surgery in order to reduce unnecessary delays before appropriate surgical intervention.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Small-bowel obstruction secondary to bezoar impaction: A diagnostic dilemma</title><author><name sortKey="Ho, Thomas W" sort="Ho, Thomas W" uniqKey="Ho T" first="Thomas W." last="Ho">Thomas W. Ho</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>General Surgery, Tan Tock Seng Hospital</s1><s2>Singapore 308433</s2><s3>SGP</s3><sZ>1 aut.</sZ></inist:fA14><country>Singapour</country><wicri:noRegion>Singapore 308433</wicri:noRegion></affiliation></author><author><name sortKey="Koh, Dean C" sort="Koh, Dean C" uniqKey="Koh D" first="Dean C." last="Koh">Dean C. Koh</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Division of Colorectal Surgery, National University of Singapore</s1><s2>Singapore</s2><s3>SGP</s3><sZ>2 aut.</sZ></inist:fA14><country>Singapour</country><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Assalia, Ahmad" sort="Assalia, Ahmad" uniqKey="Assalia A" first="Ahmad" last="Assalia">Ahmad Assalia</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Rambam Medical Center</s1><s2>Haifa</s2><s3>ISR</s3><sZ>3 aut.</sZ></inist:fA14><country>Israël</country><wicri:noRegion>Rambam Medical Center</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">07-0276482</idno><date when="2007">2007</date><idno type="stanalyst">PASCAL 07-0276482 INIST</idno><idno type="RBID">Pascal:07-0276482</idno><idno type="wicri:Area/PascalFrancis/Corpus">000429</idno><idno type="wicri:Area/PascalFrancis/Curation">000274</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000394</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000394</idno><idno type="wicri:doubleKey">0364-2313:2007:Ho T:small:bowel:obstruction</idno><idno type="wicri:Area/Main/Merge">001F89</idno><idno type="wicri:Area/Main/Curation">001F74</idno><idno type="wicri:Area/Main/Exploration">001F74</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Small-bowel obstruction secondary to bezoar impaction: A diagnostic dilemma</title><author><name sortKey="Ho, Thomas W" sort="Ho, Thomas W" uniqKey="Ho T" first="Thomas W." last="Ho">Thomas W. Ho</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>General Surgery, Tan Tock Seng Hospital</s1><s2>Singapore 308433</s2><s3>SGP</s3><sZ>1 aut.</sZ></inist:fA14><country>Singapour</country><wicri:noRegion>Singapore 308433</wicri:noRegion></affiliation></author><author><name sortKey="Koh, Dean C" sort="Koh, Dean C" uniqKey="Koh D" first="Dean C." last="Koh">Dean C. Koh</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Division of Colorectal Surgery, National University of Singapore</s1><s2>Singapore</s2><s3>SGP</s3><sZ>2 aut.</sZ></inist:fA14><country>Singapour</country><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Assalia, Ahmad" sort="Assalia, Ahmad" uniqKey="Assalia A" first="Ahmad" last="Assalia">Ahmad Assalia</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Rambam Medical Center</s1><s2>Haifa</s2><s3>ISR</s3><sZ>3 aut.</sZ></inist:fA14><country>Israël</country><wicri:noRegion>Rambam Medical Center</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">World journal of surgery</title><title level="j" type="abbreviated">World j. surg.</title><idno type="ISSN">0364-2313</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">World journal of surgery</title><title level="j" type="abbreviated">World j. surg.</title><idno type="ISSN">0364-2313</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Bezoar</term><term>Diagnosis</term><term>Foreign body</term><term>Medicine</term><term>Obstruction</term><term>Secondary</term><term>Small intestine</term><term>Surgery</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Intestin grêle</term><term>Obstruction</term><term>Secondaire</term><term>Bézoard</term><term>Diagnostic</term><term>Médecine</term><term>Chirurgie</term><term>Corps étranger</term><term>Traitement</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Médecine</term><term>Chirurgie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Gastrointestinal bezoar (GIB) is uncommon and is reported to occur in 4% of all admissions for small-bowel obstruction (SBO). Because of a lack of diagnostic features, it is often associated with a delay in treatment, with increased morbidity. In this article, we report our experience with managing bezoar-induced SBO and the role of early computed tomography (CT) imaging in establishing the diagnosis. Methods: We retrospectively reviewed all cases of bezoar-induced SBO treated in our unit between 1999 and 2005. Results: There were 43 patients, of whom 2 had a recurrence, giving a total of 45 episodes. The frequency of bezoar in our patients presenting with SBO was 4.3%. All patients were of Asian origin: 41 Chinese, 1 Indian, and 1 Malay. Twenty-eight (65%) patients had previous abdominal surgery of which 26 were gastric surgery. Thirty-eight (88%) patients were edentulous. Forty-one (91%) underwent serial abdominal radiography, whereas only 4 patients (9%) had either CT imaging or contrast study alone. Only 11 (24%) cases had a correct diagnosis of bezoar impaction made preoperatively by CT imaging. The diagnostic accuracy of CT imaging in our series was 65%, with six cases of misdiagnosis. Overall, CT led to a change in management of 76% (13 in 17). The median time to surgery from admission was 2 (0-10) days. There were 2 cases of ischemic bowel that necessitated bowel resection. The median length of hospital stay was 11 (5-100) days. Ten patients (22%) had postoperative complications, and there was one death. Conclusion: Bezoar-induced SBO is uncommon and remains a diagnostic and management challenge. It should be suspected in patients with an increased risk of formation of GIB, such as previous gastric surgery, poor dentition, and a suggestive history of increased fibre intake. We advocate that CT imaging be performed early in these at-risk patients and in patients presenting with SBO with or without a history of abdominal surgery in order to reduce unnecessary delays before appropriate surgical intervention.</div></front></TEI><affiliations><list><country><li>Israël</li><li>Singapour</li></country><orgName><li>Université nationale de Singapour</li></orgName></list><tree><country name="Singapour"><noRegion><name sortKey="Ho, Thomas W" sort="Ho, Thomas W" uniqKey="Ho T" first="Thomas W." last="Ho">Thomas W. Ho</name></noRegion><name sortKey="Koh, Dean C" sort="Koh, Dean C" uniqKey="Koh D" first="Dean C." last="Koh">Dean C. Koh</name></country><country name="Israël"><noRegion><name sortKey="Assalia, Ahmad" sort="Assalia, Ahmad" uniqKey="Assalia A" first="Ahmad" last="Assalia">Ahmad Assalia</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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