Phytobezoar: a rare cause of acute small bowel obstruction in an innocent abdomen.

Bezoars are abnormal concretions of indigestible organic material in the lumen of the gastrointestinal tract. They are named according to the predominant component material, for example, hair-trichobezoar and plant substancephytobezoar. Trichobezoars are the commonest type of bezoars. Phytobezoar is a rare type of intestinal bezoar and is defined as a compact mass of fibers, peels, seeds, leaves, roots, stems, that collect in the gastrointestinal tract. They contain large amount of indigestible materials like cellulose, lignin and tanin1. The other type of bezoar reported include pharmacobezoar in patients consuming bulk medications like cholestyramine or antacids55, lactobezoar in infants due to condensed milk3,4 and occupational bezoar specific to occupational exposure, for example, cotton bezoar in tailors11. Bezoars can occur in any part of the gastrointestinal tract but are commonly reported in the stomach. Rarely, they occur in small bowel, colon, esophagus or common bile duct7,12. Bezoars of the small bowel are rare and are conceptualized to occur secondary to migration of a gastric bezoar. Most patients have a predisposing factor such as prior gastrointestinal surgery particularly a previous gastrectomy which can facilitate transmigration14. Alternatively improper mastication as seen in extremes of age and in edentulous patients also predisposes to the formation of bezoars7. Decreased gastrointestinal motility, as seen in gastroparesis or use of tricyclic antidepressants are the other incriminated pathogenic mechanisms in the formation of bezoars. They usually present with recurrent or subacute intestinal obstruction. Phytobezoar is a rare cause of small bowel obstruction with a reported incidence of <4% in literature and only three reported cases from India1,11. Here is reported one such case in a patient without any predisposing factors with review of relevant literature.