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February 1963

Phytobezoar in Gastrectomized Patients: A Cause of Small Bowel Obstruction

Author Affiliations

From the Surgical Service, St. Luke's Hospital.

Arch Surg. 1963;86(2):264-266. doi:10.1001/archsurg.1963.01310080088020

Phytobezoar rarely is a cause of small bowel obstruction. Historically, these impactions, principally due to ingestion of green persimmons, have been well documented as occasionally forming impassable boluses in the stomach. Since the advent of subtotal gastrectomy with the concomitant ablation of the pyloric sphincter, it is becoming more evident that citrus fruit pulp, figs, coconut fiber, and poorly masticated food can be passed as a firm bolus directly into the small bowel and become the cause of a mechanical ileus.

Seifert,1 in 1930, was among the first to report a case of intestinal obstruction due to food in a 44-year-old woman who had had a subtotal gastrectomy. The obstructing agent in this patient was a sauerkraut bolus. Norberg2 has recently documented 26 gastrectomized patients operated upon in Sweden for intestinal obstruction due to a food bolus. He stressed citrus fruit pulp as the most common etiologic agent.