title: A rare case of a double phytobezoar causing gastric and jejunum obstruction in an adult man: a case report.
abstract: BACKGROUND
  Bezoars are an uncommon cause of mechanical intestinal occlusion. There are four different kinds of bezoars: phytobezoars, made of vegetables and fibers; trichobezoars, resulting from the ingestion of hair and frequently an expression of psychiatric disorders; lactobezoars, which are formed of milk curd; and pharmacobezoars, caused by drugs and medications. Symptoms are classically indistinguishable from one another and from more common causes of intestinal occlusion, so it can be difficult to establish a correct diagnosis in order to apply the correct treatment. We present a rare case of two different phytobezoars causing intestinal occlusion (gastric and jejunal). We also describe the correct techniques for making a correct and fast diagnosis of occlusion caused by phytobezoars, and the possible conservative and operative treatments.
  
  
  METHODS
  We present the case of a double phytobezoar that was surgically treated with a double enterotomy. Our patient was a 68-year-old Caucasian man with a medical history of hypertension, a previous open appendectomy, and open repair of a perforated gastric ulcer. He was admitted with a 5-day history of abdominal pain located in his upper quadrants along with vomiting. After a preoperative examination, he was taken to the operating room. He was discharged in a good clinical condition 11 days after surgical intervention. A physical examination at 6 months demonstrated our patient was in good health.
  
  
  CONCLUSIONS
  Diagnosing bezoars is difficult because of their rarity. However, they must be taken into consideration in a differential diagnosis because their treatment is not always surgical. In fact, it may be conservative in many cases and a correct diagnosis will guide towards the correct therapy.
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and Sant' Anna Universitary Hospital of Ferrara, Ferrara, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Occhionorelli
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and Sant' Anna Universitary Hospital of Ferrara, Ferrara, Italy. zsemnc@unife.it.
authors.forename: M
authors.initials: M
authors.lastname: Zese
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and Sant' Anna Universitary Hospital of Ferrara, Ferrara, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Targa
authors.affiliation: Department of Surgery, Emergency Surgery Service, Sant'Anna University Hospital, Ferrara, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cappellari
authors.affiliation: Department of Surgery, Emergency Surgery Service, Sant'Anna University Hospital, Ferrara, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Stano
authors.affiliation: Department of Surgery, Emergency Surgery Service, Sant'Anna University Hospital, Ferrara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Vasquez
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D001630:Bezoars / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D017219:Gastric Outlet Obstruction / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007583:Jejunum / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D013270:Stomach / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Bezoars; Enterotomy; Gastrostomy; Phytobezoars; Small bowel obstruction