title: ''Sandwich'' treatment for diospyrobezoar intestinal obstruction: a case report.
abstract: Intestinal obstruction is a common clinical entity encountered in surgical practice. The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on the diagnosis and treatment. A 27-year-old male presented with a history of gastric pain combined with nausea and abdominal distension that had been present for 5 d. The presence of a foreign body was detected by computed tomography and observed as an abnormal density within the stomach. A diospyrobezoar was revealed during gastroscopy, the extraction of which was prevented due to its size and firmness. An endoscopic holmium laser joined with a snare was used to fragment the obstruction, which was followed by management with a conservative "sandwich" treatment strategy involving intestinal decompression with an ileus tube and Coca-Cola lavage between endoscopic lithotripsy fragmentation procedures. This strategy resulted in the successful removal of the diospyrobezoar along with multiple small bowel obstructions. The patient was discharged after abatement of symptoms. The case presented here demonstrates the implementation of a conservative, yet successful, treatment as an alternative to conventional surgical removal of intestinal obstructions.
authors.affiliation: Yi-Xiong Zheng, Liang Hu, Li Chen, Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
authors.forename: Yi-Xiong
authors.initials: YX
authors.lastname: Zheng
authors.affiliation: Yi-Xiong Zheng, Liang Hu, Li Chen, Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Prasoon
authors.affiliation: Yi-Xiong Zheng, Liang Hu, Li Chen, Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Yi-Xiong Zheng, Liang Hu, Li Chen, Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Hu
authors.affiliation: Yi-Xiong Zheng, Liang Hu, Li Chen, Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
mesh_terms: D000328:Adult; D001630:Bezoars / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002253:Carbonated Beverages; D019299:Decompression, Surgical / Q000379:methods*; D029788:Diospyros / Q000009:adverse effects*; D005773:Gastroscopy; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D053844:Lasers, Solid-State / Q000627:therapeutic use; D017602:Lithotripsy, Laser / Q000295:instrumentation / Q000379:methods*; D008297:Male; D007507:Therapeutic Irrigation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Diospyrobezoar; Endoscopy; Holmium laser; Ileus tube; Small bowel obstruction