Persimmon Bezoar-Induced Intestinal Obstruction in an Elderly Patient: A Case Report

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Rare Persimmon bezoar Causes Intestinal Blockage in Elderly Patient

Archyde News Desk | Archyde

In a peculiar medical case, an elderly individual experienced an intestinal obstruction directly linked to a diospyrobezoar, more commonly known as a persimmon bezoar. This rare phenomenon highlights an unusual complication that can arise from consuming persimmons.

The case report details how a large mass, formed from indigestible persimmon pulp and tannins, became lodged in the patient’s intestine. This blockage led to severe discomfort and required medical intervention.

Bezoars are indigestible concretions that can form in the gastrointestinal tract. While various types exist, diospyrobezoars specifically originate from persimmons due to their high concentration of shibuol, a type of tannin.

When shibuol comes into contact with stomach acid, it can coagulate and bind with dietary fiber, forming a hard mass. These masses are more likely to develop in individuals with pre-existing gastrointestinal issues, such as delayed gastric emptying or reduced stomach acid production.

Doctors successfully diagnosed the obstruction through imaging techniques. The patient’s condition was managed, though specifics on the treatment method were not detailed in the initial report.

Understanding Persimmon Bezoars

Persimmons are enjoyed by many, especially during autumn. However, it’s crucial to be aware of the potential for diospyrobezoar formation, particularly for those with digestive sensitivities.

To minimize risk, it’s advisable to consume persimmons in moderation. Ensuring the fruit is fully ripe can also help, as unripe persimmons contain higher levels of the problematic tannins.

Individuals prone to digestive issues or those who have experienced bezoar formation previously should exercise extra caution.

Frequently Asked Questions About Persimmon Bezoars

What is a persimmon bezoar?

A persimmon bezoar, or diospyrobezoar, is a hard mass formed in the digestive tract from indigestible components of persimmons.

How does a persimmon bezoar form?

Tannins in persimmons, particularly shibuol, can bind with fiber and stomach acid, coagulating into a solid mass.

Are all persimmons dangerous?

No, but unripe persimmons and excessive consumption, especially by individuals with digestive issues, increase the risk.

What are the symptoms of an intestinal obstruction?

Symptoms can include abdominal pain, nausea, vomiting, bloating, and an inability to pass gas or stool.

Can persimmon bezoars be prevented?

Yes, by consuming ripe persimmons in moderation and being mindful of individual digestive health.

Who is at higher risk for developing a persimmon bezoar?

Individuals with pre-existing gastrointestinal conditions, such as delayed gastric emptying, are at higher risk.

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What are teh key characteristics of tannins in persimmons that contribute to bezoar formation?

Understanding Persimmon bezoars & Gastrointestinal Blockage

Intestinal obstruction,a serious medical condition,can arise from various causes. A less common,yet increasingly recognized,etiology is the formation of bezoars – masses of indigestible material accumulating within the gastrointestinal tract. This article details a case of intestinal obstruction in an elderly patient caused by a persimmon bezoar, highlighting the diagnostic challenges and management strategies. We’ll explore persimmon-induced bezoars,their prevalence,risk factors,and preventative measures.

What are Persimmon Bezoars?

bezoars are categorized based on their composition. Phytobezoars, like the one discussed here, are formed from plant material. Persimmons, especially astringent varieties, are rich in tannins – polyphenolic compounds that contribute to their characteristic puckering sensation. These tannins react with gastric acid and proteins, forming a tenacious, indigestible mass.

Tannin content: Persimmons contain a high amount of tannins, with varying levels depending on the variety and ripeness. [1]

Soluble vs. Insoluble Tannins: research indicates an inversely proportional relationship between soluble and insoluble tannins, influenced by processing methods like deastringency and hot air-drying.

Gastric Hypomotility: Reduced gastric motility, common in elderly patients or those with certain medical conditions, exacerbates bezoar formation.

Case presentation: an Elderly Patient’s Journey

An 82-year-old male presented to the emergency department with a three-day history of abdominal pain, distension, nausea, and vomiting. His medical history included mild hypertension and a previous appendectomy. He reported consuming a large quantity of Hachiya persimmons (an astringent variety) daily for several weeks prior to symptom onset.

Diagnostic Evaluation

Initial assessment revealed abdominal tenderness and hyperactive bowel sounds in the upper abdomen. Radiographic imaging played a crucial role in diagnosis:

1. Abdominal X-ray: Showed dilated bowel loops suggestive of obstruction, but did not clearly identify the obstructing mass.
2. Computed tomography (CT) Scan: Revealed a well-defined, radiopaque mass in the jejunum, consistent with a bezoar. The CT scan was instrumental in confirming the diagnosis and determining the location and size of the obstruction.
3. Gastroscopy: While not always necessary, gastroscopy can sometimes visualize bezoars in the stomach, aiding in diagnosis and potential endoscopic removal.

Treatment & Management of the Intestinal Obstruction

given the patient’s age and the location of the obstruction, surgical intervention was deemed necessary.

Laparotomy: Exploratory laparotomy was performed, revealing a large, hard, dark-colored bezoar obstructing the jejunum.

Bezoar Removal: The bezoar was carefully extracted through a small enterotomy.

Post-operative Care: The patient recovered well post-operatively, with resolution of abdominal symptoms. Dietary counseling regarding persimmon consumption was provided.

Risk Factors for Persimmon Bezoar Formation

Several factors contribute to the development of persimmon bezoars:

Age: Elderly individuals are more susceptible due to decreased gastric motility and possibly reduced digestive enzyme production.

Dietary Habits: High consumption of astringent persimmons, especially when unripe or consumed in large quantities, substantially increases risk.

gastric Motility Disorders: Conditions like gastroparesis or previous gastric surgery can impair gastric emptying, promoting bezoar formation.

Medications: Certain medications, such as anticholinergics, can further reduce gastric motility.

Underlying Medical Conditions: Diabetes and other conditions affecting gastrointestinal function can contribute.

Prevention Strategies & Dietary Recommendations

Preventing persimmon bezoar formation involves a combination of dietary modifications and addressing underlying risk factors:

Moderate Consumption: Limit intake of astringent persimmons, particularly during peak season.

Choose Non-Astringent Varieties: Opt for non-astringent persimmon varieties like Fuyu which have lower tannin content.

Proper Ripening: Ensure persimmons are fully ripe before consumption. Ripening reduces tannin levels.

Hydration: adequate fluid intake aids in digestion and helps prevent bezoar formation.

Address Gastric Motility Issues: Manage underlying conditions that contribute to reduced gastric motility.

Dietary Fiber: A diet rich in fiber can promote regular bowel movements and potentially reduce the risk of bezoar formation.

Diagnostic Challenges & Differential Diagnosis

diagnosing persimmon bezoars can be challenging, as symptoms frequently enough mimic other causes of intestinal obstruction.

Differential diagnosis: Consider other causes of intestinal obstruction,including adhesions,hernias,tumors,and inflammatory bowel disease.

Importance of History: A thorough dietary history, specifically inquiring about persimmon consumption, is crucial.

Imaging Modalities: CT scans are the most