July 1974

Paper Bezoar Causing Intestinal Obstruction

Arch Surg. 1974;109(1):123. doi:10.1001/archsurg.1974.01360010097023

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To the Editor.—Vegetable fiber bezoars (phytobezoars) often appear as acute bowel obstruction. This letter reports another obstructing agent and emphasizes certain clinical points.

A 30-year-old woman was admitted with periumbilical pain, nausea, and vomiting. She had multiple pelvic but no gastric procedures. There was no history of mental disorder. Results of the physical examination were essentially normal, except for moderate periumbilical tenderness. Roentgenograms showed evidence of small bowel obstruction. Laparotomy revealed an obstructed ileum. Enterostomy after unsuccessful "milking" produced a 7 × 6.5 × 1-cm oblong paper bezoar, 10 cm from the ileocecal valve. Subsequently the patient revealed having eaten, 24 hours before admission, several napkins during a telephone conversation, a long-standing "nervous habit."

This seems to be the first published case of paper bezoar. Intestinal obstruction is the usual presentation of phytobezoars, excepting those caused by persimmon pulp, which characteristically lodge in the stomach. Various vegetables and fruits,

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