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文献考察：bezoarによる小腸閉塞87例
J Am Coll Surg. 1994 Sep;179(3):285-8.
Intestinal obstruction and bezoars.
Escamilla C, Robles-Campos R, Parrilla-Paricio P, Lujan-Mompean J, Liron-Ruiz R, Torralba-Martinez JA.
BACKGROUND: Bezoars are large conglomerates of vegetable fibers, hairs, or concretions of various substances located in the stomach or small intestine of humans and certain animals, mainly ruminants. Gastrointestinal bezoars have constituted a relatively common clinical reality ever since the introduction of truncal vagotomy associated with drainage or gastric resection in the treatment of gastroduodenal peptic ulcer. STUDY DESIGN: This study presents a series of 87 cases of intestinal bezoar treated in our department of general surgery. Analysis was made of data obtained retrospectively from clinical histories, together with a clinical and endoscopic review of the patients. RESULTS: Most of the patients had had previous operative treatment (76.3 percent), the most commonly used technique being bilateral truncal vagotomy plus pyloroplasty (75.8 percent). An excessive intake of vegetable fiber was revealed in 39.5 percent of the cases, and alterations in dentition and mastication in 24 percent. Operative treatment was used in all patients. We attempted to fragment the bezoar and milk it to the cecum. Enterotomy and bezoar extraction were reserved for cases where fragmentation was impossible, as enterotomy was associated with more complications (p
要旨：食餌性イレウスの手術の際, 胆石イレウス同様に複数の胃石が存在する可能性があるので全腸管(特に胃)を検索する事と，砕けるものなら砕いて盲腸へ用手的に誘導し(milking), 内容物みたさの腸切開はできるだけ避けることが大事．87例中20例の合併症(腹腔内膿瘍, 創感染)があったが, そのうち17例は腸管切開した例であった． また, 87例中12例が再発したので, 食事指導, 歯の治療を徹底させるべきである．
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