Is Abdominal Computed Tomography Helpful for the Management of an Intestinal Obstruction Caused by a Bezoar?

zoars are the most common type of foreign body lodged in any part of the gastrointestinal tract, the overall incidence of bezoarinduced intestinal obstruction remains relatively low. Incidence of intestinal obstruction caused by bezoars is 2 to 4% [9]. The differential diagnosis of intestinal obstruction secondary to bezoars is difficult before surgery because the clinical and the radiographic findings are similar to those of intestinal obstruction attributable to other causes. However, findings from recent studies suggest that sonography or computed tomography (CT) can be useful in diagnosing bezoars before surgery [6, 10]. CT scans demonstrate a well-defined round, heterogeneous intraluminal mass in the gastrointestinal tract. The mass can be outlined by the bowel wall and presents a characteristic internal gas bubble-soft tissue appearance [11-14]. Kement et al. [3] reported that abdominal CT was carried out in 16 patients and that bezoars were revealed in 14 (77.7%) of those patients before surgery. In this paper, the accuracy of abdominal CT in diagnosing bezoars was 47% (7 of 15 patients). The authors compared the clinical courses of three groups, patients who were preoperatively diagnosed with bezoars by using abdominal CT (group 3), patients who were not diagnosed using abdominal CT (group 2), and patients who did not undergo abdominal CT (group 1). In the group 3, because of the abdominal CT earlier surgery was possible (0.6 days vs. 4.9 days, P = 0.036), and the incidence of postoperative complications was lower (14.3% vs. 37.5%, 40%, P = 0.439). However, as the authors addressed, there are some limitations in this study. The hospital stay was little longer in group 3 than group 2, and heterogeneity of the patients’ clinical courses is expected. In patients with intestinal obstructions, differential diagnosis is very important, especially in patients with a history of previous abdominal surgery. CT can help to make this differentiation. Therefore, CT should be performed whenever possible in all patients with bowel obstruction to establish the diagnosis and to avoid inappropriate treatment.