mushtaq ahmed chowdhary

Bezoars are non-dissolved hard masses of undigested or partially digested food or foreign material that are trapped in the gastrointestinal tract. Bezoars are broadly classified into four groups, viz; phytobezoars, trichobezoar, lactobezoars, and pharmacobezoars. One of the common sub-types of phytobezoars is amlookobezoar (diospyrobezoar).

To describe the clinical profile and treatment outcome of a series of patients of amlookobezoar presenting with small bowel obstruction.

This prospective observational case-series study includes five patients of both sexes presenting with small bowel obstruction (SBO) caused due to amlookobezoar. All patients were evaluated with respect to detailed history, physical examination and radiological assessment to confirm the diagnosis. Radiological assessment included X-ray abdomen, USG and CECT abdomen.

We had total of five cases of SBO caused due to amlookobezoars. The age of these patients ranged from 8-years to 22-years with male-female ratio of 4:1. All the 5 patients in this series presented with the features of SBO in the autumn months. None of our patients had any other significant predisposing factor for bezoar formation except that all of these patients had taken significant amount of amlooks (persimmon fruit) 3-10days earlier. Four patients eventually required the exploratory laparotomy. All the four patients had soft to firm bezoars stuck up in distal or mid-ileum. Fortunately in all these 4 patients, we were able to manually breakdown the amlookobezoars and milk them down beyond the ileocaecal level without the need for any enterotomy, gut resection or creation of stoma. In all of the 4 operated patients, the postoperative period was almost uneventful.

Though uncommon, but amlookobezoars should be considered as differential diagnosis in a case of small bowel obstruction. Amlookobezoars commonly affects young adolescent males in the autumn months and often needs a laparotomy with fragmentation and milking down of amlookobezoars.

The aim of this study was to evaluate the surgical approach in post traumatic diaphragmatic hernia. This prospective cross-sectional study was conducted in the Department of cardiovascular and thoracic surgery, Sher-i- Kashmir Institute of Medical Sciences (SKIMS), Kashmir, India. We included all patients with post traumatic diaphragmatic hernia undergoing operation in our center from May 2009 to November 2011. A detailed history was taken for each patient along with comprehensive general, physical, systemic and local examination of all cases. Operative findings included associated intra-abdominal injuries, and herniated intra-abdominal organs. Post-operative complications, mortality and survival were recorded and reported. The mean age of the patients was 32±1 years and there were 16 (76.1%) men and 5 (23.8%) women among the patients. Thoracotomy was performed in 14 patients (66.7%), laparotomy in 6 patients (28.6%) and combined procedure was used in 1 patient (4.7%). The reduction of hernia contents with repair of diaphragmatic rent was done in 11 (52.2%) of the patients and splenectomy with repair of rent in 6 (28.6%). Traumatic diaphragmatic hernia had 81.8% survival rate, no pre-operative mortality and 14.3% post operative mortality rate. Thoracotomy is the most common approach in post traumatic diaphragmatic hernia. Laparotomy is preferred in patients having acute trauma with associated intra-abdominal injuries.