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01.12.2012 | Review | Ausgabe 1/2012 Open Access

World Journal of Emergency Surgery 1/2012

A rare cause of gastrointestinal phytobezoars: diospyros lotus

World Journal of Emergency Surgery > Ausgabe 1/2012
Gökhan Ertuğrul, Murat Coşkun, Mahsuni Sevinç, Behzat Yelimlieş, Fisun Ertuğrul, Toygar Toydemir
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1749-7922-7-19) contains supplementary material, which is available to authorized users.

Competing interests

I declare that I have no competing interests.

Authors’ contributions

G E, M C, B Y and F E performed the surgeries. G E, M S and T T analyzed and interpreted the data. G E was the main author of the manuscript. All authors read and approved the final manuscript.



Diospyros Lotus (“Wild Date Palm of Trabzon or Persimmon”), which has been proven to cause phytobezoars, is a widely consumed fruit in the Black Sea and Northeast Anatolia regions of Turkey. The aim of the present study was to investigate the effects of Diospyros Lotus together with other predisposing factors, on the development of gastrointestinal phytobezoars and to discuss the treatment results in comparison to the literature.

Material and method

The records of 13 patients, who had been admitted to the General Surgery Clinic of Düzce Atatürk State Hospital between August 2008 and August 2011, were retrospectively reviewed. Demographic characteristics, predisposing factors, clinical and radiological findings, diagnostic and therapeutic methods, and the outcomes of the patients were recorded from the patient files. Written informed consent was obtained from each patient for publication of this research article and accompanying images.


All the patients had a history of consuming Diospyros Lotus. Of the patients, 30,7% had a history of previous gastric surgery, 30,7% had diabetes mellitus and 23% had dental implants. None of the patients had hypothyroidism, which is another predisposing factor for phytobezoars.
The phytobezoars were located in the stomach alone in 23% of the patients, whereas 15,3% was detected in the jejunum and stomach, 15,3% was detected in the jejunum alone, and 46,1% was detected in the ileum alone. All patients were treated with surgery, and there were no deaths.


Gastric phytobezoars are rare. Preventive measures have particular importance in the management of this condition, which is difficult to treat. For this purpose, excessive consumption of herbal nutrients containing a high amount of indigestible fibers such as Diospyros Lotus should be avoided in patients with a history of gastrointestinal surgery or poor oral and dental health.
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