Introduction: Intestinal obstruction is a common disease encountered in pediatric population and among the most common causes of emergency admissions. Foreign bodies in the intestinal lumen are commonly seen in pediatric population and are mostly swallowed accidentally. Intestinal bezoars are a rare cause of intestinal obstruction in children. The aim of the study was to evaluate the patients of small intestinal obstruction due to a specific phytobezoar-persimmon seeds (date plum or amlook)-in pediatric age group in our region in terms of clinical presentation, management and complications. Materials and Methods: Data of 100 patients of intestinal obstruction due to dry persimmon phytobezoar (date plum or amlook) were evaluated retrospectively by clinical presentation, clinical examination, radiological investigations and the management options, and intra-operative finding were noted from hospital records. Results: Out of 100 patients' records were evaluated, and the commonest presentations were abdominal pain in 92 patients, abdominal distension in 91, nausea and vomiting in 85 and constipation in 30 patients. 18 patients were managed conservatively, 56 patients underwent exploratory laparotomy with milking of food bolus, 20 patients underwent enterotomy with removal of food bolus and in 6 patients' resection with end to end anastomosis (REEA) was done. Conclusion: Intestinal obstruction due to dry persimmon phytobezoar (date plum or amlook) food bolus should be suspected in all patients where this fruit is commonly used as in our region and mass education of people in the region should be done.

We aimed to present a patient with phytobezoar causing small bowel obstruction after Roux-en-Y gastric bypass. Thirty-year-old woman with a history of prior Roux-en-Y gastric bypass due to morbid obesity three years ago presented with colicky abdominal pain, distention, nausea, vomiting, and obstipation. Initial abdominal X-ray showed various distended small bowel loops with air-fluid levels. The patient was taken to operation room for laparoscopic exploration, and a phytobezoar was found in distal jejunum. The bezoar was fragmented and flushed through cecum. The patient tolerated the surgery and her symptoms relieved without complication. Moreover, she received dietary consultation in order to prevent future recurrences. Small bowel obstruction in a patient with prior abdominal surgery is mainly caused due to adhesions, stenosis of anastomosis and hernias. An uncommon cause for obstruction is bezoar formation. The majority of patients with bezoars have a history of gastric surgery. Diagnostic imaging is not always helpful, and surgical exploration is sometimes required for diagnosis. Treatment is mainly surgical, but conservative medical treatment is also reported to be helpful. Apart from removal of bezoar, a dietary consultation is required to avoid eating habits leading to bezoar formation. Bariatric surgery is becoming more common; thus its complications are becoming more common as well. Majority of patients with bezoars have a prior history of gastric surgery. Therefore it is important to maintain a high level of suspicion for timely diagnosis of bezoars in patients with prior history of bariatric surgery, especially Roux-en-Y gastric bypass.

Background and Objective: Bezoar is a mass or indigestible substance that accumulates in the gastrointestinal tract, especially in the stomach. The formation of gastric bezoars (especially phytobezoars) is rare in children,however, when they are formed, they present a therapeutic challenge due to their hard composition and consistency as well as their large size. Case Report: A 7-year-old boy with an abdominal mass was investigated in this case report. The patient had eaten a lot of persimmons and pomegranates in the past. Gastroduodenoscopy revealed a large phytobezoar in the stomach, which was removed and treated using a gastroduodenoscope. Conclusion: The gastroduodenoscopic technique is cost-effective in the treatment of gastrointestinal bezoars and has fewer complications for the patient than the surgery.

Introduction: Gastric bezoars are formed by accumulation of non - digestible material in the stomach. They are found mostly in patients with delayed gastric emptying or special psychiatric diseases. Therapeutic options are medical dissolution therapy and endoscopic techniques. Surgery options are kept for refractory or emergency cases.Case Presentation: We report 2 cases of successful non surgery, endoscopic treatment of huge gastric bezoars, which were refractory to medical dissolution therapy and conventional endoscopic techniques such as bezoar fragmentation by polypectomy snare, Basket, Argon Plasma Coagulation device, and different types of foreign body retrieval forceps. In June 2015 and September 2017 in the Namazi hospital (Shiraz University of Medical Sciences, Iran) bezoars fragmentation were conducted successfully by electrohydraulic lithotripsy catheter (Nortech Aoutolith and copy, Northgate technologies, INC.) under direct visualization during the endoscopy. This instrument is primarily designed to crush urinary tract and bile ducts stones avoiding open surgery. Taking the advantages of its capabilities, we used electrohydraulic lithotripsy catheter for huge gastric bezoar fragmentation.Conclusions: In the endoscopic treatment refractory gastric bezoars, electrohydraulic lithotripsy can be used as an excellent alternative option to surgery. This technique is safe, feasible, and uncomplicated without any need for surgery.

Aim: The current study aimed to investigate the risk factors, endoscopic findings, and treatments of upper gastrointestinal bezoars. Background: Bezoars are compact masses formed by the accumulation of dietary fiber, undigested food, hair, or medications. The majority of bezoars are asymptomatic, but they may cause serious symptoms or even life-threatening events such as bleeding, obstruction, or perforation Methods: This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019. Bezoars were detected in 109 of 15, 830 endoscopy records (0. 68%). Results A total of 103 patients (52. 4% male) were enrolled in this study. Mean patient age was 60. 5± 11. 3 years. The most frequent risk factors were history of gastric surgery (25. 2%), diabetes mellitus (21. 3%), hypothyroidism (15. 5%), trichophagia (5. 8%), and anxiety disorders (2. 9%), respectively. The most common endoscopic findings were peptic ulcers (34. 9%), erosive gastritis/duodenitis (12. 6%), and reflux esophagitis (10. 6%). While bezoars were most commonly observed in the stomach (84. 4%), the majority of them were phytobezoars (92. 2%). The mean number of endoscopic interventions for each patient was 1. 5 (range, 1-4). Endoscopy was successful in removing bezoars in 85. 4%. Conclusion: The synergistic effect of multiple factors for a long time, such as gastrointestinal surgery, diabetes mellitus or psychiatric disorders, may lead to bezoar formation. These risk factors should be avoided or treated in order to prevent bezoar formation and subsequent life-threatening complications.

A few cases with esophageal bezoar have been reported in achalasia. We describe here a rare case of esophageal pharmacobezoar after ingestion of ferrous sulfate capsules in a patient with achalasia. A 29-year-old woman presented with severe dysphagia since five days earlier. She had history of achalasia since 3 years ago but had refused any treatment option. After about 3 weeks of ferrous sulfate capsules ingestion, she developed severe dysphagia and was referred to a gastroenterologist. Physical examination was unremarkable. A barium swallow revealed dilated esophagus and bird’ s beak appearance. Esophagogastroduodenoscopy (EGD) showed dilated esophagus and soft black color bezoar in distal part of esophagus. The bezoar was retrieved with basket. In the next endoscopic session, achalasia balloon dilation was successfully applied. Ferrous sulfate capsules can cause pharmacobezoar in patients with achalasia. Esophageal bezoar should be considered in differential diagnosis of untreated achalasia and acute exacerbation of dysphagia.