{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T06:04:57Z","timestamp":1759730697660,"version":"3.41.0"},"reference-count":26,"publisher":"International College of Surgeons","issue":"7-8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:p>Owing to their rare occurrence, persimmon bezoars are often overlooked as a cause of small bowel obstruction. We herein report a small bowel obstruction in a 67-year-old Japanese female who regularly consumed persimmons in autumn. The patient presented to our hospital with typical complaints of abdominal distension with pain for 2 days. Based on the patient's history of a cesarean section 34 years ago, we initially diagnosed her with small bowel obstruction resulting from adhesions and placed an ileus tube. At first, the patient rejected the operation in spite of our recommendation. After 10 days, because the ileus tube was unable to relieve the obstruction, finally surgery was scheduled. Upon releasing the obstruction by partial resection of the small bowel, we found an impacted bezoar without any evidence of adhesions. After stone analysis, we first realized her regular persimmon intake. This case serves as an important reminder to obtain dietary history in order to investigate all possible causes of small bowel obstruction when intestinal obstruction is suspected.<\/jats:p>","DOI":"10.9738\/intsurg-d-14-00269.1","type":"journal-article","created":{"date-parts":[[2015,11,23]],"date-time":"2015-11-23T19:38:25Z","timestamp":1448307505000},"page":"1194-1198","source":"Crossref","is-referenced-by-count":7,"title":["Intestinal Obstruction Caused by Persimmon Bezoar: A Case Report"],"prefix":"10.9738","volume":"100","author":[{"given":"Naotake","family":"Funamizu","sequence":"first","affiliation":[{"name":"Department of Surgery, The Jikei University School of Medicine, Daisan Hospital, Komae, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomotaka","family":"Kumamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Jikei University School of Medicine, Daisan Hospital, Komae, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Jikei University School of Medicine, Daisan Hospital, Komae, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyoshi","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Jikei University School of Medicine, Daisan Hospital, Komae, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuhiko","family":"Yanaga","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4721","reference":[{"issue":"983","key":"i0020-8868-100-7-1194-b01","series-title":"Br J Radiol","first-page":"901","article-title":"Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients","volume":"82","author":"Hewitt\n              AN,","year":"2009","unstructured":"Hewitt\n              AN, \n            \n              Levine\n              MS, \n            \n              Rubesin\n              SE, \n            \n              Laufer\n              I.\n            \n          \n          Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol2009;82(983):901\u2013907"},{"key":"i0020-8868-100-7-1194-b02","series-title":"Feldman M, Friedman LS, Sleisengar MH, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Diseases. 7th ed","first-page":"395","article-title":"Foreign bodies and bezoars","author":"Pfau\n              P,","year":"2002","unstructured":"Pfau\n              P, \n            \n              Ginsberg\n              G.\n            \n          \n          Foreign bodies and bezoars. In: Feldman M, Friedman LS, Sleisengar MH, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Diseases. 7th ed. Philadelphia, PA: WB Saunders Company, 2002:395\u2013397"},{"issue":"9","key":"i0020-8868-100-7-1194-b03","series-title":"Agric Biol Chem","first-page":"1637","article-title":"The chemical structure of kaki-tannin from immature fruit of persimmon","volume":"42","author":"Matsuo\n              T,","year":"1978","unstructured":"Matsuo\n              T, \n            \n              Ito\n              S.\n            \n          \n          The chemical structure of kaki-tannin from immature fruit of persimmon. Agric Biol Chem1978;42(9):1637\u20131643"},{"issue":"11","key":"i0020-8868-100-7-1194-b04","series-title":"Isr Med Assoc J","first-page":"829","article-title":"Unexpected cause of large bowel obstruction: colonic bezoar","volume":"10","author":"Bala\n              M,","year":"2008","unstructured":"Bala\n              M, \n            \n              Appelbaum\n              L, \n            \n              Almogy\n              G.\n            \n          \n          Unexpected cause of large bowel obstruction: colonic bezoar. Isr Med Assoc J2008;10(11):829\u2013830"},{"issue":"11\u201312","key":"i0020-8868-100-7-1194-b05","series-title":"Med J Aust","first-page":"613","article-title":"The fascinating history of bezoars","volume":"145","author":"Williams\n              RS.","year":"1986","unstructured":"Williams\n              RS.\n            \n          \n          The fascinating history of bezoars. Med J Aust1986;145(11\u201312):613\u2013614"},{"issue":"6\u20137","key":"i0020-8868-100-7-1194-b06","series-title":"Gastroenterol Clin Biol","first-page":"596","article-title":"A report of 15 cases of small-bowel obstruction secondary to phytobezoars: predisposing factors and diagnostic difficulties","volume":"32","author":"Bedioui\n              H,","year":"2008","unstructured":"Bedioui\n              H, \n            \n              Daghfous\n              A, \n            \n              Ayadi\n              M, \n            \n              Noomen\n              R, \n            \n              Chebbi\n              F, \n            \n              Rebai\n              W\n            \n            et al\n          . A report of 15 cases of small-bowel obstruction secondary to phytobezoars: predisposing factors and diagnostic difficulties. 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Korean J Gastrointest Endosc2001;22(3):182\u2013186"},{"key":"i0020-8868-100-7-1194-b08","series-title":"BMJ Case Rep","article-title":"Colonic phytobezoar","volume":"2009","author":"Lee\n              SJ,","year":"2009","unstructured":"Lee\n              SJ, \n            \n              Chu\n              SJ, \n            \n              Tsai\n              SH.\n            \n          \n          Colonic phytobezoar. BMJ Case Rep2009;2009:bcr2006039412"},{"issue":"5","key":"i0020-8868-100-7-1194-b09","series-title":"Am J Surg","first-page":"526","article-title":"Surgical aspects of gastrointestinal persimmon phytobezoar treatment","volume":"152","author":"Krausz\n              MM,","year":"1986","unstructured":"Krausz\n              MM, \n            \n              Moriel\n              EZ, \n            \n              Ayalon\n              A, \n            \n              Pode\n              D, \n            \n              Durst\n              AL.\n            \n          \n          Surgical aspects of gastrointestinal persimmon phytobezoar treatment. Am J Surg1986;152(5):526\u2013530"},{"issue":"4","key":"i0020-8868-100-7-1194-b10","series-title":"Gastrointest Endosc","first-page":"581","article-title":"Persimmon bezoars: a successful combined therapy","volume":"55","author":"Gay\u00e0\n              J,","year":"2002","unstructured":"Gay\u00e0\n              J, \n            \n              Barranco\n              L, \n            \n              Llompart\n              A, \n            \n              Reyes\n              J, \n            \n              Obrador\n              A.\n            \n          \n          Persimmon bezoars: a successful combined therapy. Gastrointest Endosc2002;55(4):581\u2013583"},{"issue":"1","key":"i0020-8868-100-7-1194-b11","series-title":"AJR Am J Roentgenol","first-page":"65","article-title":"Gastrointestinal bezoars: sonographic and CT characteristics","volume":"177","author":"Ripoll\u00e9s\n              T,","year":"2001","unstructured":"Ripoll\u00e9s\n              T, \n            \n              Garc\u00eda-Aguayo\n              J, \n            \n              Mart\u00ednez\n              MJ, \n            \n              Gil\n              P.\n            \n          \n          Gastrointestinal bezoars: sonographic and CT characteristics. AJR Am J Roentgenol2001;177(1):65\u201369"},{"issue":"2","key":"i0020-8868-100-7-1194-b12","series-title":"Surg Clin North Am","first-page":"341","article-title":"Phytobezoars following gastric surgery for duodenal ulcer","volume":"52","author":"Buchholz\n              RR,","year":"1972","unstructured":"Buchholz\n              RR, \n            \n              Haisten\n              AS.\n            \n          \n          Phytobezoars following gastric surgery for duodenal ulcer. Surg Clin North Am1972;52(2):341\u2013352"},{"issue":"9","key":"i0020-8868-100-7-1194-b13","series-title":"World J Gastroenterol","first-page":"960","article-title":"Synergistic effect of multiple predisposing risk factors on the development of bezoars","volume":"18","author":"Kement\n              M,","year":"2012","unstructured":"Kement\n              M, \n            \n              Ozlem\n              N, \n            \n              Colak\n              E, \n            \n              Kesmer\n              S, \n            \n              Gezen\n              C, \n            \n              Vural\n              S.\n            \n          \n          Synergistic effect of multiple predisposing risk factors on the development of bezoars. World J Gastroenterol2012;18(9):960\u2013964"},{"issue":"12","key":"i0020-8868-100-7-1194-b14","series-title":"World J Gastroenterol","first-page":"1813","article-title":"et al. Gastrointestinal bezoars: a retrospective analysis of 34 cases","volume":"11","author":"Erzurumlu\n              K,","year":"2005","unstructured":"Erzurumlu\n              K, \n            \n              Malazgirt\n              Z, \n            \n              Bektas\n              A, \n            \n              Dervisoglu\n              A, \n            \n              Polat\n              C, \n            \n              Senyurek\n              G\n            \n          \n          et al. Gastrointestinal bezoars: a retrospective analysis of 34 cases. World J Gastroenterol2005;11(12):1813\u20131817"},{"issue":"1","key":"i0020-8868-100-7-1194-b15","series-title":"Korean J Gastroenterol","first-page":"32","article-title":"Clinical analysis of Bezoars","volume":"23","author":"Park\n              JW,","year":"1991","unstructured":"Park\n              JW, \n            \n              Park\n              JG, \n            \n              Kwon\n              OK, \n            \n              Lee\n              KU, \n            \n              Hong\n              SC, \n            \n              Choe\n              KJ\n            \n            et al\n          . Clinical analysis of Bezoars. Korean J Gastroenterol1991;23(1):32\u201338"},{"issue":"5","key":"i0020-8868-100-7-1194-b16","series-title":"J Radiol","first-page":"641","article-title":"Mechanical small bowel obstruction due to bezoars: correlation between CT and surgical findings","volume":"83","author":"Billaud\n              Y,","year":"2002","unstructured":"Billaud\n              Y, \n            \n              Pilleul\n              F, \n            \n              Valette\n              PJ.\n            \n          \n          Mechanical small bowel obstruction due to bezoars: correlation between CT and surgical findings. J Radiol2002;83(5):641\u2013646"},{"issue":"3","key":"i0020-8868-100-7-1194-b17","series-title":"Radiology","first-page":"705","article-title":"Small bowel phytobezoars: detection with radiography","volume":"172","author":"Verstandig\n              AG,","year":"1989","unstructured":"Verstandig\n              AG, \n            \n              Klin\n              B, \n            \n              Bloom\n              RA, \n            \n              Hadas\n              I, \n            \n              Libson\n              E.\n            \n          \n          Small bowel phytobezoars: detection with radiography. Radiology1989;172(3):705\u2013707"},{"issue":"5","key":"i0020-8868-100-7-1194-b18","series-title":"Am J Gastroenterol","first-page":"397","article-title":"Enzymatic softening and endoscopic destruction of a phytobezoar in an unoperated stomach","volume":"64","author":"Rozen\n              P,","year":"1975","unstructured":"Rozen\n              P, \n            \n              Gilat\n              T.\n            \n          \n          Enzymatic softening and endoscopic destruction of a phytobezoar in an unoperated stomach. Am J Gastroenterol1975;64(5):397\u2013399"},{"issue":"8","key":"i0020-8868-100-7-1194-b19","series-title":"Am J Dig Dis","first-page":"717","article-title":"Gastric bezoars: a technique of endoscopic removal","volume":"23","author":"Madsen\n              R,","year":"1978","unstructured":"Madsen\n              R, \n            \n              Skibba\n              RM, \n            \n              Galvan\n              A, \n            \n              Striplin\n              C, \n            \n              Scott\n              P.\n            \n          \n          Gastric bezoars: a technique of endoscopic removal. Am J Dig Dis1978;23(8):717\u2013719"},{"issue":"10","key":"i0020-8868-100-7-1194-b20","series-title":"Am J Gastroenterol","first-page":"1663","article-title":"Update on the medicinal management of phytobezoars","volume":"88","author":"Walker-Renard\n              P.","year":"1993","unstructured":"Walker-Renard\n              P.\n            \n          \n          Update on the medicinal management of phytobezoars. Am J Gastroenterol1993;88(10):1663\u20131666"},{"issue":"2","key":"i0020-8868-100-7-1194-b21","series-title":"Aliment Pharmacol Ther","first-page":"169","article-title":"Zouboulis-Vafiadis. Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment","volume":"37","author":"Ladas\n              SD,","year":"2013","unstructured":"Ladas\n              SD, \n            \n              Kamberoglou\n              D, \n            \n              Karamanolis\n              G, \n            \n              Vlachogiannakos\n              J, \n          \n          Zouboulis-Vafiadis. Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment. Aliment Pharmacol Ther2013;37(2):169\u2013173"},{"issue":"4","key":"i0020-8868-100-7-1194-b22","series-title":"Korean J Intern Med","first-page":"300","article-title":"Acute intestinal obstruction caused by a persimmon phytobezoar after dissolution therapy with Coca-Cola","volume":"22","author":"Ha\n              SS,","year":"2007","unstructured":"Ha\n              SS, \n            \n              Lee\n              HS, \n            \n              Jung\n              MK, \n            \n              Jeon\n              SW, \n            \n              Cho\n              CM, \n            \n              Kim\n              SK\n            \n            et al\n          . Acute intestinal obstruction caused by a persimmon phytobezoar after dissolution therapy with Coca-Cola. Korean J Intern Med2007;22(4):300\u2013303"},{"issue":"7","key":"i0020-8868-100-7-1194-b23","series-title":"Br J Surg","first-page":"1000","article-title":"Gastrointestinal bezoars","volume":"81","author":"Robles\n              R,","year":"1994","unstructured":"Robles\n              R, \n            \n              Parrilla\n              P, \n            \n              Escamilla\n              C, \n            \n              Lujan\n              JA, \n            \n              Torralba\n              JA, \n            \n              Liron\n              R\n            \n            et al\n          . Gastrointestinal bezoars. Br J Surg1994;81(7):1000\u20131001"},{"issue":"3","key":"i0020-8868-100-7-1194-b24","series-title":"Gastroenterology","first-page":"627","article-title":"Small bowel obstruction secondary to enzymatic digestion of a gastric bezoar","volume":"84","author":"Rumley\n              TO,","year":"1983","unstructured":"Rumley\n              TO, \n            \n              Hocking\n              MP, \n            \n              King\n              CE.\n            \n          \n          Small bowel obstruction secondary to enzymatic digestion of a gastric bezoar. 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Endoscopy1997;29(5):424\u2013426"},{"issue":"4","key":"i0020-8868-100-7-1194-b26","series-title":"Am J Gastroenterol","first-page":"313","article-title":"Intestinal obstruction due to bezoars","volume":"79","author":"Goldstein\n              SS,","year":"1984","unstructured":"Goldstein\n              SS, \n            \n              Lewis\n              JH, \n            \n              Rothstein\n              R.\n            \n          \n          Intestinal obstruction due to bezoars. 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