Plain abdominal radiographs may show dilated intestinal loops, air-fluid levels and thickened intestinal wall [17]. Barium radiography Duvelisib is contraindicated in patients with suspected complete obstruction and perforation. Phytobezoars may appear as an echogenic intraluminal mass and a remarkable posterior acoustic shadowing on abdominal ultrasound [21–23]. A dilated small bowel loop with a well-defined, round-shaped, heterogeneous, intraluminal mass distally, is typical on abdominal computed tomography.
It typically appears as an intraluminal soft tissue mass that contains air bubbles [9, 17, 24, 25]. Upper www.selleckchem.com/products/ch5183284-debio-1347.html gastrointestinal endoscopy can detect all of the gastric phytobezoars, but just 12% of the small bowel phytobezoars[26]. In the present study, diagnosis was made by abdominal tomography in 11 (84,6%), and upper gastrointestinal endoscopy in two patients. Gastric lavage, and endoscopic or surgical techniques, can be used in
the treatment of Proteasome inhibitor gastrointestinal phytobezoars. L-cysteine, metoclopramide and cellulose, papain and cellulose, pineapple juice, normal saline solution, sodium bicarbonate, hydrochloric acid, pancrelipase, pancreatin, 1-2% zinc chloride, and coca cola are used for the disintegration of the bezoar during gastric lavage [3, 19, 27–29]. Hayashi et al. observed that there was a significant decrease in the size and a significant softening in the structure of the phytobezoar by giving 500–1000 ml coca cola before each meal for three weeks, and they removed the mass using endoscopic forceps [30]. The first successful outcomes concerning endoscopic removal of gastric phytobezoars were published in 1972 by McKechnie[31]. Endoscopic disintegration requires normal pyloric function and absence of duodenal obstruction [27]. If the phytobezoar is not large in size, it can be removed using a basket catheter or by direct aspiration [25]. Surgical therapy may be performed either
by open or laparoscopic technique. Main surgical techniques include manual fragmentation and milking to cecum, gastrotomy, enterotomy, and resection and anastomosis in complicated cases. As the prevalence of concurrent gastric and small intestine crotamiton phytobezoars is 17-21%, care should be given not to leave any residue during surgery [32, 33]. Chisholm et al. performed endoscopic removal in one (6,2%), gastrotomy together with manual fragmentation and milking into cecum in one (6,2%), manual fragmentation and milking into cecum in nine (56,2%), enterotomy in four (25%), and small intestine resection and anastomosis in one (6,2%) patient [12]. In a study conducted by Krausz et al., 14 (12,3%) patients underwent gastrotomy, 62 patients (54,8%) underwent manual fragmentation and milking into cecum, 34 patients (30%) underwent enterotomy, and two patients (1,7%) underwent small intestine resection and anastomosis [10].