Amlookobezoar’: A Case Series on Diospyrobezoars Causing acute Small bowel Obstruction

Introduction: Bezoars are non-dissolved hard masses of undigested or partially digested food or foreign material trapped in the gastrointestinal tract, broadly classified into four groups: phytobezoars, trichobezoars, lactobezoars, and pharmacobezoars. In the Indian subcontinent, the persimmon fruit is called ‘amlook’; hence, phytobezoars resulting from the ingestion of the unripe or excessive amlook are called ‘amlookobezoars’ in local medical vernacular or dialect. To describe the clinical profile and treatment outcome of a series of patients presenting with small bowel obstruction (SBO) due to amlookobezoars. Case Presentation: Five patients of SBO caused by amllookbeoar were evaluated with a detailed history, physical examination, and radiological assessment to confirm the diagnosis. The radiological assessment included abdominal X-rays, ultrasonography, and contrast-enhanced computed tomography. We had five cases of SBO caused by amlookobezoars. The age of these patients ranged from 8 to 22 years, with a male-female ratio of 4:1. All five patients presented in autumn. None had any other significant predisposing factor for bezoar formation except consuming considerable amounts of amlooks 3–10 days earlier. Four patients eventually required an exploratory laparotomy; all had soft to firm bezoars stuck in the distal or mid-ileum. For these four patients, we manually broke down the amlookobezoars and milked them down beyond the ileocaecal level without requiring any enterotomy, gut resection, or stoma creation, and the postoperative period was almost uneventful. Conclusion: Though uncommon, amlookobezoars should be considered a differential diagnosis in small bowel obstruction. Amlookobezoars commonly affect young adolescent males in the autumn months and often need a laparotomy with fragmentation and milking.